Key result
In individuals with idiopathic autonomic neuropathy, transit times were predominately delayed in the foregut (50%), while contractility abnormalities were more prominent in the hindgut (85%), corresponding with autonomic reflex abnormalities.
Why the study?
Recent advances in wireless motility capsule testing may provide insight into segment-specific enteric involvement of peripheral neuropathies affecting autonomic nervous system function.
Cross-Sectional (n=20)
No
In patients with idiopathic autonomic neuropathy, wireless motility capsule testing reveals segment-specific gastrointestinal dysmotility that correlates with standardized autonomic nervous system function measures.
Wireless motility capsule may identify segment-specific GI dysmotility in autonomic neuropathies; leaves open need for prospective validation before clinical adoption.
Purpose: Peripheral neuropathies with autonomic nervous system involvement are a recognized cause of gastrointestinal dysmotility for a wide spectrum of diseases. Recent advances in wireless motility capsule testing allow improved sampling of regional and whole gut motility to aid in the diagnosis of gastrointestinal motility disorders and may provide additional insight into segment-specific enteric involvement of peripheral neuropathies affecting autonomic nervous system function. Methods: We utilized standardized autonomic nervous system (ANS) reflex assessment and wireless motility capsule testing to evaluate 20 individuals with idiopathic autonomic neuropathy and unexplained gastrointestinal symptoms. Additionally, we examined the relationship between quantifiable autonomic neuropathy and gastrointestinal dysmotility at specific neuroanatomical levels. Symptom profiles were evaluated using the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS-31) and compared to wireless motility capsule data. Results: We found that transit times were predominately abnormal (delayed) in the foregut (10 of 20; 50%), while contractility abnormalities were far more prominent in the hindgut (17 of 20; 85%), and that motility and symptom patterns, as assessed by the COMPASS-31 GI domain items, generally corresponded. Finally, we also found that there was neuroanatomical overlap in the presence of autonomic reflex abnormalities and WMC-based transit and/or contractility abnormalities. Conclusions: We found that transit times were predominately abnormal in the foregut and midgut, while contractility abnormalities were far more prominent in the hindgut in individuals with idiopathic autonomic neuropathy. There was a high rate of agreement in segmental wireless motility capsule data with neuroanatomically corresponding standardized ANS function measures (e.g., cardiovagal, sudomotor, adrenergic). Expanded sudomotor testing, including additional neuroanatomical segments, could provide additional indirect assessment of visceral involvement in ANS dysfunction.
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Langford et al. (2022) conducted a cross-sectional in Idiopathic autonomic neuropathy with unexplained gastrointestinal symptoms (n=20). Idiopathic autonomic neuropathy vs. Normative ranges was evaluated on Abnormal segmental transit times and contractility on wireless motility capsule testing. In individuals with idiopathic autonomic neuropathy, transit times were predominately delayed in the foregut (50%), while contractility abnormalities were more prominent in the hindgut (85%), corresponding with autonomic reflex abnormalities.
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