Autonomic Dysregulation and Enteric Nerve Changes in the Pathophysiology of Diabetic Gastroparesis.
Previous work on the pathophysiology of diabetic gastroparesis (DM Gp) has focused on a number of areas, primarily on blood sugar control (BSC), gastric emptying (GET), and autonomic functioning (ANS), with a more recent emphasis on electrograms (EGs) and full thickness biopsies (FTB). DM Gp can be viewed as representing a loss of the normal regulation of the systems measured by these areas, resulting in the pathophysiologic mechanisms leading to the clinical manifestations of the disorder of DM Gp. This application explores the pathophysiology of Diabetic Gastroparesis (DM Gp) and, in particular, dysregulation in autonomic and enteric mechanisms with the overall goal to construct a model of the pathophysiology of Diabetic Gastroparesis that delineates dysregulation of autonomic and enteric pathways. This protocol has 3 aims: First, to study any associations between gastric mucosal electrograms (mEG) and gastric mucosal neuronal density (MND) in clinical DM Gp patients. Second, to investigate mucosal electrograms and gastric mucosal neuronal density associations and compare them to measures of systemic autonomic function by heart rate variability (HRV) in consecutive DM Gp patients. Third, to compare mucosal electrograms, gastric mucosal neuronal density, and heart rate variability to established measures of serosal electrograms (sEG), gastric full thickness biopsies (FTB) and traditional autonomic function testing (ANS) in patients with symptoms of DM Gp. The overall goal of the study is to construct a model of the pathophysiology of Diabetic Gastroparesis that delineates dysregulation of autonomic and enteric pathways. Thus, this protocol allows an investigation of autonomic deregulation and enteric nerve changes in the pathophysiology of diabetic gastroparesis in three ways: first, by studying mucosal electrograms and gastric mucosal neuronal density, secondly, by comparing them to measures of systemic autonomic function by heart rate variability and thirdly, by comparing the electrograms, gastric mucosal neuronal density, and heart rate variability to established measures of serosal electrograms gastric full thickness biopsies and traditional autonomic function testing.

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