Roentgenologic Study of the Small Intestine

Abstract

The gastro-intestinal tract is richly supplied with nervous tissue, both intrinsic and extrinsic. The former consists of plexuses beneath the mucosa and between the muscular layers; the latter consists of sympathetic and parasympathetic connections with the central nervous system. Golden and others (2, 5) have suggested that the grossly disturbed function and altered roentgen appearance of the intestine in severe nutritional disorders such as sprue may be due to degeneration of the nerves supplying the gut. Important as the autonomic nerves undoubtedly are in controlling the motor and secretory functions of the gastro-intestinal tract, the clinical manifestations of neurogenic intestinal dysfunction in less exotic diseases certainly are not well established. This may be due to the fact that organic diseases restricted to the autonomic neurons are rare, and that the presenting abnormalities ordinarily relate to disturbed orthostatic blood pressure regulation, defective sweating or thermal regulation, bladder paralysis, etc. We have approached the problem of investigating the possible role of the autonomic nerves in causing disturbed motor function of the intestinal tract by carrying out roentgen studies in selected patients with well defined neurologic disease. Several categories of patients were used (Table I). Since our previous clinical studies (9) have shown that autonomic nerve disease occurs to an unusual extent in patients with diabetic neuropathy and gives rise to strikingly unusual gastro-intestinal symptoms, this group was of particular interest. Intestinal and bladder disturbances are common in the neurologic disease occurring as a manifestation of pernicious anemia, in tabes dorsalis, etc. Other opportunities for investigation occurred in patients in whom the vagus nerves were sectioned in the treatment of intractable peptic ulcer or incidentally during total or subtotal gastric resection. The effect of splanchnicectomy and lower thoracic ganglionectomy was studied in patients in whom this operation was carried out for the treatment of arterial hypertension. An example of autonomic nerve paralysis occurring spontaneously as a disease entity was also included in the study. It was hoped that investigation of material of this type might contribute to our basic knowledge of neurogenic intestinal dysfunction. Diabetic Neuropathy At the outset of the disease individuals afflicted with diabetes mellitus have but one defect, a deficiency of insulin. Under optimal conditions this deficiency can be corrected and health maintained indefinitely. All too frequently, however, imperfect regulation over the course of years permits the development of complications, among which is to be found a characteristic degenerative disease affecting the peripheral nerves. The neurologic disorder resulting from diabetes is a chronic, and often severe, neuropathy with an unusual predilection for the autonomic nerves.