Premium
Enteric cholinergic neuropathy in patients with diabetes: Non‐invasive assessment with positron emission tomography
Author(s) -
Klinge Mette W.,
Borghammer Per,
Lund Sten,
Fedorova Tatyana,
Knudsen Karoline,
Haase AnneMette,
Christiansen Jens Juel,
Krogh Klaus
Publication year - 2020
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13731
Subject(s) - interquartile range , medicine , positron emission tomography , standardized uptake value , gastroenterology , diabetes mellitus , nuclear medicine , endocrinology
Abstract Background 11 C‐Donepezil positron emission tomography (PET) allows non‐invasive assessment of cholinergic innervation of visceral organs. We aimed to compare cholinergic innervation in the gut in patients with diabetes mellitus (DM) and in healthy controls (HC). Methods 11 C‐Donepezil PET and computed tomography (CT) were performed in 19 patients with type 1 DM and gastrointestinal symptoms and in 19 age‐ and sex‐matched HC in a cross‐sectional design. Key Results All patients had severe gastrointestinal symptoms when assessed by standard questionnaires. DM patients had significantly increased volume of the small intestinal wall (DM: median 557 cm 3 [interquartile range [IQR] 446‐697] vs HC median: 448 cm 3 [IQR; 341‐518; P < .01]), and the 11 C Donepezil PET uptake was reduced in patients (DM: median 7.08 standardized uptake value [SUV] [IQR; 5.94‐8.43] vs HC: median 9.18 SUV [IQR; 8.57‐10.11; P < .01]). A similar pattern was found in colon (DM: median volume 1064 cm 3 [IQR; 882‐1312] vs HC: median 939 cm 3 [IQR; 785‐1081; P = .13] and DM: median 1.22 SUV (IQR; 1.08‐1.36) vs HC: median 1.42 SUV (IQR; 1.32‐1.53; P = .03). Furthermore, patients had significantly reduced pancreatic volume (DM: median 53 cm 3 [IQR; 41‐69] vs HC: median 98 cm 3 [IQR;82‐110; P < .01]) and reduced PET uptake of the pancreas (DM: median 13.14 SUV [IQR;9.58‐15.82] vs HC: median 21.46 SUV [IQR;18.97‐24.06; P < .01]) as well as the adrenal gland (DM: median 7.62 SUV [IQR;7.61;15.82] vs HC: median 15.51 SUV [IQR;12.22;19.49; P = .03]). Conclusion and Inferences Assessed with 11 C‐Donepezil PET/CT, patients with DM and severe bowel symptoms have reduced cholinergic innervation of the gut indicative of parasympathetic denervation.