Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures

Ditte S. Kornum; Christina Brock; Tina Okdahl; Davide Bertoli; Huda Kufaishi; Anne-Marie Wegeberg; Katrine L. Høyer; Esben B. Mark; Birgitte Brock; Christian S. Hansen; Filip K. Knop; Asbjørn M. Drewes; Klaus Krogh

doi:10.1111/nmo.14956

Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures

Ditte S. Kornum, Christina Brock, Tina Okdahl, Davide Bertoli, Huda Kufaishi, Anne-Marie Wegeberg, Katrine L. Høyer, Esben B. Mark, Birgitte Brock, Christian S. Hansen, Filip K. Knop, Asbjørn M. Drewes, Klaus Krogh

9 Citations (Scopus)

Abstract

BACKGROUND: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.

METHODS: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.

KEY RESULTS: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.

CONCLUSIONS & INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

Original language	English
Article number	e14956
Journal	Neurogastroenterology and Motility
Volume	38
Issue number	1
ISSN	1350-1925
DOIs	https://doi.org/10.1111/nmo.14956
Publication status	Published - Jan 2026

Keywords

cardiovascular diagnostic technic
diabetic autonomic neuropathy
enteric neuropathy
gastrointestinal motility
gastrointestinal transit
signs and symptoms, digestive
Autonomic Nervous System/physiopathology
Gastrointestinal Motility/physiology
Humans
Middle Aged
Gastrointestinal Diseases/physiopathology
Male
Gastroparesis/physiopathology
Diabetes Mellitus, Type 2/complications
Diabetes Mellitus, Type 1/complications
Gastric Emptying/physiology
Female
Adult
Diabetic Neuropathies/physiopathology
Aged

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Kornum, D. S., Brock, C., Okdahl, T., Bertoli, D., Kufaishi, H., Wegeberg, A.-M., Høyer, K. L., Mark, E. B., Brock, B., Hansen, C. S., Knop, F. K., Drewes, A. M., & Krogh, K. (2026). Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures. Neurogastroenterology and Motility, 38(1), Article e14956. https://doi.org/10.1111/nmo.14956

Kornum, DS, Brock, C, Okdahl, T, Bertoli, D, Kufaishi, H, Wegeberg, A-M, Høyer, KL, Mark, EB, Brock, B, Hansen, CS, Knop, FK, Drewes, AM & Krogh, K 2026, 'Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures', Neurogastroenterology and Motility, vol. 38, no. 1, e14956. https://doi.org/10.1111/nmo.14956

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title = "Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures",

abstract = "BACKGROUND: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.METHODS: We included 81 persons with type 1 or type 2 diabetes (65\% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill{\texttrademark}) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS{\texttrademark}) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN{\texttrademark} evaluated sudomotor function.KEY RESULTS: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95\% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95\% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.CONCLUSIONS \& INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.",

keywords = "cardiovascular diagnostic technic, diabetic autonomic neuropathy, enteric neuropathy, gastrointestinal motility, gastrointestinal transit, signs and symptoms, digestive, Autonomic Nervous System/physiopathology, Gastrointestinal Motility/physiology, Humans, Middle Aged, Gastrointestinal Diseases/physiopathology, Male, Gastroparesis/physiopathology, Diabetes Mellitus, Type 2/complications, Diabetes Mellitus, Type 1/complications, Gastric Emptying/physiology, Female, Adult, Diabetic Neuropathies/physiopathology, Aged",

author = "Kornum, \{Ditte S.\} and Christina Brock and Tina Okdahl and Davide Bertoli and Huda Kufaishi and Anne-Marie Wegeberg and H{\o}yer, \{Katrine L.\} and Mark, \{Esben B.\} and Birgitte Brock and Hansen, \{Christian S.\} and Knop, \{Filip K.\} and Drewes, \{Asbj{\o}rn M.\} and Klaus Krogh",

note = "{\textcopyright} 2024 The Author(s). Neurogastroenterology \& Motility published by John Wiley \& Sons Ltd.",

year = "2026",

month = jan,

doi = "10.1111/nmo.14956",

language = "English",

volume = "38",

journal = "Neurogastroenterology and Motility",

issn = "1350-1925",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "1",

}

TY - JOUR

T1 - Diabetic gastroenteropathy

T2 - Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures

AU - Kornum, Ditte S.

AU - Brock, Christina

AU - Okdahl, Tina

AU - Bertoli, Davide

AU - Kufaishi, Huda

AU - Wegeberg, Anne-Marie

AU - Høyer, Katrine L.

AU - Mark, Esben B.

AU - Brock, Birgitte

AU - Hansen, Christian S.

AU - Knop, Filip K.

AU - Drewes, Asbjørn M.

AU - Krogh, Klaus

PY - 2026/1

Y1 - 2026/1

N2 - BACKGROUND: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.METHODS: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.KEY RESULTS: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.CONCLUSIONS & INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

AB - BACKGROUND: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.METHODS: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.KEY RESULTS: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.CONCLUSIONS & INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

KW - cardiovascular diagnostic technic

KW - diabetic autonomic neuropathy

KW - enteric neuropathy

KW - gastrointestinal motility

KW - gastrointestinal transit

KW - signs and symptoms, digestive

KW - Autonomic Nervous System/physiopathology

KW - Gastrointestinal Motility/physiology

KW - Humans

KW - Middle Aged

KW - Gastrointestinal Diseases/physiopathology

KW - Male

KW - Gastroparesis/physiopathology

KW - Diabetes Mellitus, Type 2/complications

KW - Diabetes Mellitus, Type 1/complications

KW - Gastric Emptying/physiology

KW - Female

KW - Adult

KW - Diabetic Neuropathies/physiopathology

KW - Aged

UR - https://www.scopus.com/pages/publications/85208069867

U2 - 10.1111/nmo.14956

DO - 10.1111/nmo.14956

M3 - Journal article

C2 - 39485948

SN - 1350-1925

VL - 38

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

IS - 1

M1 - e14956

ER -

Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures

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