Abstract
The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastrointestinal tract is a common finding in AD, but no commercially available method exists for direct verification of enteric dysfunction. Thus, assessing segmental enteric physiological function is recommended to aid diagnostics and guide treatment. Several established assessment methods exist, but disadvantages such as lack of standardization, exposure to radiation, advanced data interpretation, or high cost, limit their utility. Emerging methods, including high-resolution colonic manometry, 3D-transit, advanced imaging methods, analysis of gut biopsies, and microbiota, may all assist in the evaluation of gastroenteropathy related to AD. This review provides an overview of established and emerging assessment methods of physiological function within the gut and assessment methods of autonomic neuropathy outside the gut, especially in regards to clinical performance, strengths, and limitations for each method.
Highlights
Autonomic disorders may involve the parasympathetic, sympathetic, and enteric nervous systems with extensive, multisystemic consequences [1]
Methods for assessment of GI motility are generally applicable across autonomic dysfunction (AD) etiologies despite different underlying pathophysiology
When enteric neuropathy is suspected in a patient with an autonomic disorder, the Whenapproach enteric neuropathy is other suspected in a patient with autonomic disorder, the primary is to exclude plausible causes of thean gastrointestinal symptoms, primary approach is to cancer, excludeinflammatory other plausible causes of the gastrointestinal symptoms, such as gastrointestinal bowel disease, exocrine pancreas insufficiency, such as gastrointestinal bowel disease, exocrine pancreas insuffibile acid malabsorption,cancer, coeliacinflammatory disease, and porphyria
Summary
Autonomic disorders may involve the parasympathetic, sympathetic, and enteric nervous systems with extensive, multisystemic consequences [1]. Do the motility disturbances contribute to GI symptoms, they may affect the absorption of medication used to treat the underlying disease [3,4]. Methods for assessment of GI motility are generally applicable across autonomic dysfunction (AD) etiologies despite different underlying pathophysiology. Verification of the extent of GI involvement is important to support diagnosis and guide effective treatment, especially because gastrointestinal symptoms and objective measures correlate poorly [5,6,7,8]. Commercially available assessment methods have different inherent limitations, and better techniques are needed for evaluating GI dysfunction.
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