Autonomic nerve dysfunction in pathologically obese patients

Abstract

Background. Obese patients frequently present clinical symptoms related to gastrointestinal motility alterations and autonomic nervous system dysfunction. Aim. To evaluate the possible correlation between cardiovascular autonomic nervous dysfunction and oesophageal motility in pathologically obese patients. Patients and methods. Enrolled in the study were 22 patients with a body mass index of 45.72±7.48 and 10 control subjects, all within 20% of their ideal weight. Oesophageal motility was measured by stationary manometry and scintigraphic transit. Tests for the evaluation of autonomic nervous system were: Valsalva ratio, deep breathing, sustained handgrip, sudormotor axon reflex test and spectral analysis of the variability of R-R interval. Results. The mean pressure of oesophageal peristaltic waves in patients and controls was 39.36±14 mmHg and 73±12 mmHg, respectively. The scintigraphic mean transit time was 22.96±16.26 seconds in patients and 10.23±16.26 seconds in controls (p<0.001). Spectral analysis of the variability of the R-R interval showed an increase in the parasympathetic component both in the lying and standing position compared to controls. The other autonomic nervous system function tests showed no significant difference between obese patients and controls. Conclusions. These results suggest that obese patients present a reduction of oesophageal transit and autonomic nervous system dysfunction albeit no direct correlation was found between these phenomena.