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Idiopathic autonomic denervation in eight patients presenting with functional gastrointestinal disease

A causal association?

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Abstract

Gut dysmotility may result from disease of the extrinsic neural pathways supplying the gut. We report the results of studies on sweating, cardiovascular, and sudomotor reflexes in eight prospectively evaluated patients with apparently functional gastrointestinal disorders. There was no personal or family history of neurologic disease, except for one patient with known atony of the bladder. Motility of the esophagus, stomach, and small intestine were, respectively, abnormal in two, six, and seven patients and showed either uncoordination of contractions between segments or postcibal hypomotility. All had generalized or patchy anhidrosis; quantitative sudomotor axon reflex tests were also abnormal in four patients and borderline in one. Plasma levels of catecholamines were abnormal in one patient. All patients had evidence of sympathetic denervation: preganglionic in two patients, postganglionic in five patients, and mixed in one patient. Three patients also had abnormal heart-rate responses to deep breathing, suggesting parasympathetic dysfunction. No underlying cause for the autonomic dysfunction was identified in any of these patients despite extensive investigations. Thus, these data support the hypothesis that apparently functional gastrointestinal disorders may be due to idiopathic autonomic denervation.

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References

  1. Lennard-Jones JE: Functional gastrointestinal disorders. N Engl J Med 308:431–435, 1983

    PubMed  Google Scholar 

  2. Manning AP, Thompson WG, Heaton KW, Morris AF: Towards positive diagnosis of the irritable bowel. Br Med J 2:653–654, 1978

    PubMed  Google Scholar 

  3. Kruis W, Thieme Ch, Weinziehl M, Schussler P, Holl J, Paulus W: A diagnostic score for the irritable bowel syndrome. Gastroenterology 87:1–7, 1984

    PubMed  Google Scholar 

  4. Camilleri M, Thompson DG, Malagelada J-R: Functional dyspepsia: Symptoms and underlying mechanism. J Clin Gastroenterol 8:424–429, 1986

    PubMed  Google Scholar 

  5. Alvarez WC: The chronic “dyspeptic,” and some of the things that may be wrong with him.In Nervousness, Indigestion and Pain. New York, Paul B Hoeber, 1943, pp 221–229

    Google Scholar 

  6. Almy TP, Abbott FK, Hinkle LE: Alteration in colonic function in man under stress IV. Hypomotility of the sigmoid colon and its relationship to the mechanism of functional diarrhea. Gastroenterology 15:95–103, 1950

    PubMed  Google Scholar 

  7. Chaudhary NA, Truelove SC: Human colonic motility: A comparative study of normal subjects, patients with ulcerative colitis, and patients with the irritable bowel syndrome. I. Resting patterns of motility. Gastroenterology 40:1–17, 1961

    PubMed  Google Scholar 

  8. Camilleri M, Malagelada J-R, Kao PC, Zinsmeister AR: Gastric and autonomic responses to stress in functional dyspepsia. Dig Dis Sci 31:1169–1177, 1986

    PubMed  Google Scholar 

  9. Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987

    PubMed  Google Scholar 

  10. Horowitz L, Farrar JT: Intraluminal small intestinal pressure in normal patients and in patients with functional gastrointestinal disorders. Gastroenterology 42:455–464, 1962

    PubMed  Google Scholar 

  11. Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR: Dysmotility of the small intestine in irritable bowel syndrome. Gut 19:1236–1243, 1988

    Google Scholar 

  12. Trotman IF, Misiewicz JJ: Sigmoid motility in diverticular disease and the irritable bowel syndrome. Gut 29:218–222, 1988

    PubMed  Google Scholar 

  13. Palmer R, Stonehill E, Crist AH, Misiewicz JJ, Waller SL: Psychological characteristics of patients with irritable bowel syndrome. Postgrad Med J 50:416–419, 1974

    PubMed  Google Scholar 

  14. Smart HL, Atkinson M: Abnormal vagal function in irritable bowel syndrome. Lancet 2:475–478, 1987

    PubMed  Google Scholar 

  15. Ogilvie AL, James PD, Atkinson M: Impairment of vagal function in reflux esophagitis. Q J Med 54:61–74, 1985

    PubMed  Google Scholar 

  16. Chakraborty TK, Ogilvie AL, Heading RC, Ewing DJ: Abnormal cardiovascular reflexes in patients with gastroesophageal reflux. Gut 30:46–49, 1989

    PubMed  Google Scholar 

  17. White A, Upton A, Collins SM: Is irritable bowel syndrome the asthma of the gut? Gastroenterology 94:494, 1988 (abstract)

    PubMed  Google Scholar 

  18. Camilleri M, Malagelada J-R, Stanghellini V, Fealey RD, Sheps SG: Gastrointestinal motility disturbances in patients with orthostatic hypotension. Gastroenterology 88:1852–1860, 1985

    PubMed  Google Scholar 

  19. Fich A, Camilleri M, Phillips SF: Effect of age on human gastric and small bowel motility. J Clin Gastroenterol 11:416–420, 1989

    PubMed  Google Scholar 

  20. Jiang N-S, Machicek D: Measurement of catecholamines by liquids chromatography with amperometric detection.In Parveg (ed). Progress in HPLC, Vol 2. Utrecht, VNU Science Press, 1988, pp 395–424

    Google Scholar 

  21. Fealey RD, Schirger A, Thomas JE: Orthostatic hypotension.In Clinical Medicine, Vol 7. JA Spittell (ed). Philadelphia, Harper and Row Publishers, 1985, pp 1–12.

    Google Scholar 

  22. Fealey RD, Low PA, Thomas JE: Thermoregulatory sweating abnormalities diabetes mellitus. Mayo Clin Proc 64:617–628, 1989

    PubMed  Google Scholar 

  23. Low PA: Quantitation of autonomic responses.In Peripheral Neuropathy. PJ Dyck, PK Thomas, EA Lambert, R Bunge (eds). Philadelphia, WB Saunders, 1984, pp 1139–66.

    Google Scholar 

  24. Cohen J, Low PA, Fealey RD, Sheps S, Jiang N-S: Somatic and autonomic function of progressive autonomic failure, and multiple system atrophy. Ann Neurol 22:692–699, 1987

    PubMed  Google Scholar 

  25. Colemont LJ, Camilleri M: Chronic intestinal pseudoobstruction: Diagnosis and treatment. Mayo Clin Proc 64:60–70, 1989

    PubMed  Google Scholar 

  26. Sodhi N, Camilleri M, Camoriano JK, Low PA, Fealey RD, Perry MC: Autonomic function and motility in intestinal pseudoobstruction caused by paraneoplastic syndrome. Dig Dis Sci 34:1937–1942, 1989

    PubMed  Google Scholar 

  27. Buysschaert M, Donckier J, Dive A, Ketelslegers J-M, Lambert AE: Gastric acid and pancreatic polypeptide responses to sham feeding are impaired in diabetic subjects with autonomic neuropathy. Diabetes 34:1181–1185, 1988

    Google Scholar 

  28. Mackay JD, Page MM, Cambridge J, Watkins PJ: Diabetic autonomic neuropathy: The diagnostic value of heart rate monitoring. Diabetologia 18:471–478, 1980

    PubMed  Google Scholar 

  29. Camilleri M: Organic basis for symptoms in functional gastrointestinal disease? Mayo Clinic Proc 63:1256–1257, 1988

    Google Scholar 

  30. Snape WJ, Matarazzo SA, Cohen S: Effect of eating and gastrointestinal hormones on human colonic myoelectrical and motor activity. Gastroenterology 75:373–379, 1978

    PubMed  Google Scholar 

  31. Stanghellini V, Camilleri M, Malagelada J-R: Chronic idiopathic intestinal pseudoobstruction: Observations on clinical and manometric findings in 42 cases. Gut 28:5–12, 1987

    PubMed  Google Scholar 

  32. Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973

    PubMed  Google Scholar 

  33. Whitehead WG, Engel BT, Schuster MM: Irritable bowel syndrome. Physiological and psychological differences between diarrhea-predominant and constipation-predominant patient. Dig Dis Sci 25:404–413, 1980

    PubMed  Google Scholar 

  34. Martyn CN, Ewing DJ: Pupil cycle time: A simple way of measuring an autonomic reflex. J Neurol Neurosurg Psychiatry 49:771–774, 1986

    PubMed  Google Scholar 

  35. Esler M, Jennings G, Korner P, Blombery P, Burke F, Willett I, Leonard P: Total and organ-specific, noradrenaline plasma kinetics in essential hypertension. Clin Exp Hypertens 6:507–521, 1984

    Google Scholar 

  36. Brown MJ, Jenner DA, Allison DJ, Dollery CT: Variations in individual organ release of noradrenaline measurement by an improved radioenzymatic technique: Limitations of peripheral venous measurements in the assessment of sympathetic venous activity. Clin Sci 61:585–590, 1981

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Divisions of Gastroenterology and Neurology, Mayo Clinic and Mayo Foundation, 55905, Rochester, Minnesota

    M. Camilleri MD & R. D. Fealey MD

Authors
  1. M. Camilleri MD
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  2. R. D. Fealey MD
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This work was supported in part by the Mayo Digestive Diseases Core Center (USPHS NIH grant DK34988) and the Mayo Foundation.

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Camilleri, M., Fealey, R.D. Idiopathic autonomic denervation in eight patients presenting with functional gastrointestinal disease. Digest Dis Sci 35, 609–616 (1990). https://doi.org/10.1007/BF01540409

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  • DOI: https://doi.org/10.1007/BF01540409

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