Abstract
The records of 113 consecutive patients with a suspected gastrointestinal motility disorder referred between January 1988 and July 1991 were retrospectively reviewed. The aims were to identify the prevalence of autonomic dysfunction in those with or without associated neurological disease and to determine the diagnostic value of testing for autonomic dysfunction. All patients had gastrointestinal manometry (3 hours fasting, 2 hours fed), 94 of 113 underwent testing of sympathetic adrenergic and cholinergic function and cardiovagal cholinergic function. All tests were scored in a standard manner. There was a significant (p < 0.05) but modest (r = 0.28) rank correlation between autonomic and motility scores. This correlation was stronger (r = 0.67, p = 0.01) in diabetic patients. The number of patients in each group with autonomic dysfunction was as follows: irritable bowel syndrome nine of 33, idiopathic upper gastrointestinal dysmotility six of 21, diabetes mellitus nine of 13, identified non-diabetic neurological syndromes six of nine, postvagotomy or abdominal surgery three of 11, and myopathic pseudo-obstruction two of seven. Autonomic testing is useful in the assessment of autonomic involvement outside the gastrointestinal tract. Logistic discriminant analysis showed that autonomic function testing did not add to the diagnostic value of motility tests in distinguishing between patients with and without irritable bowel syndrome, although a slight improvement was indicated for identifying neuropathic dysmotilities. Thus, the aetiological role of general autonomic dysfunction in irritable bowel syndrome and idiopathic and postvagotomy dysmotilities deserves further study. The addition of autonomic function tests does not add substantially to the diagnostic accuracy of clinical, radiological, endoscopic, and manometric techniques in most patients referred for evaluation of a suspected motility disorder.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Buysschaert M., Donckier J., Dive A., Ketelslegers J. M., Lambert A. E. Gastric acid and pancreatic polypeptide responses to sham feeding are impaired in diabetic subjects with autonomic neuropathy. Diabetes. 1985 Nov;34(11):1181–1185. doi: 10.2337/diab.34.11.1181. [DOI] [PubMed] [Google Scholar]
- Camilleri M. Disorders of gastrointestinal motility in neurologic diseases. Mayo Clin Proc. 1990 Jun;65(6):825–846. doi: 10.1016/s0025-6196(12)62574-9. [DOI] [PubMed] [Google Scholar]
- Camilleri M., Fealey R. D. Idiopathic autonomic denervation in eight patients presenting with functional gastrointestinal disease. A causal association? Dig Dis Sci. 1990 May;35(5):609–616. doi: 10.1007/BF01540409. [DOI] [PubMed] [Google Scholar]
- Camilleri M. Jejunal manometry in distal subacute mechanical obstruction: significance of prolonged simultaneous contractions. Gut. 1989 Apr;30(4):468–475. doi: 10.1136/gut.30.4.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chakraborty T. K., Ogilvie A. L., Heading R. C., Ewing D. J. Abnormal cardiovascular reflexes in patients with gastro-oesophageal reflux. Gut. 1989 Jan;30(1):46–49. doi: 10.1136/gut.30.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cunningham K. M., Horowitz M., Riddell P. S., Maddern G. J., Myers J. C., Holloway R. H., Wishart J. M., Jamieson G. G. Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease. Gut. 1991 Dec;32(12):1436–1440. doi: 10.1136/gut.32.12.1436. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fich A., Neri M., Camilleri M., Kelly K. A., Phillips S. F. Stasis syndromes following gastric surgery: clinical and motility features of 60 symptomatic patients. J Clin Gastroenterol. 1990 Oct;12(5):505–512. [PubMed] [Google Scholar]
- Heatley R. V., Collins R. J., James P. D., Atkinson M. Vagal function in relation to gastro-oesophageal reflux and associated motility changes. Br Med J. 1980 Mar 15;280(6216):755–757. doi: 10.1136/bmj.280.6216.755. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kellow J. E., Gill R. C., Wingate D. L. Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology. 1990 May;98(5 Pt 1):1208–1218. doi: 10.1016/0016-5085(90)90335-x. [DOI] [PubMed] [Google Scholar]
- Kellow J. E., Phillips S. F. Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology. 1987 Jun;92(6):1885–1893. doi: 10.1016/0016-5085(87)90620-2. [DOI] [PubMed] [Google Scholar]
- Marlett J. A., Code C. F. Effects of celiac and superior mesenteric ganglionectomy on interdigestive myoelectric complex in dogs. Am J Physiol. 1979 Nov;237(5):E432–E443. doi: 10.1152/ajpendo.1979.237.5.E432. [DOI] [PubMed] [Google Scholar]
- Mearin F., Camilleri M., Malagelada J. R. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986 Jun;90(6):1919–1925. doi: 10.1016/0016-5085(86)90262-3. [DOI] [PubMed] [Google Scholar]
- Metz C. E. Basic principles of ROC analysis. Semin Nucl Med. 1978 Oct;8(4):283–298. doi: 10.1016/s0001-2998(78)80014-2. [DOI] [PubMed] [Google Scholar]
- Read N. W. Functional gastroenterological disorders: the name's the thing ... Gut. 1987 Jan;28(1):1–4. doi: 10.1136/gut.28.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz T. W., Holst J. J., Fahrenkrug J., Jensen S. L., Nielsen O. V., Rehfeld J. F., de Muckadell O. B., Stadil F. Vagal, cholinergic regulation of pancreatic polypeptide secretion. J Clin Invest. 1978 Mar;61(3):781–789. doi: 10.1172/JCI108992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stanghellini V., Camilleri M., Malagelada J. R. Chronic idiopathic intestinal pseudo-obstruction: clinical and intestinal manometric findings. Gut. 1987 Jan;28(1):5–12. doi: 10.1136/gut.28.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Summers R. W., Anuras S., Green J. Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoobstruction. Gastroenterology. 1983 Dec;85(6):1290–1300. [PubMed] [Google Scholar]