Subclinical sympathetic neuropathy appears early in the course of Crohn's disease

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Research article

Subclinical sympathetic neuropathy appears early in the course of Crohn's disease

Bodil Ohlsson1 , Göran Sundkvist* 2,3 and Stefan Lindgren* 1

1Department of Clinical Sciences, Gastroenterology Division, Entrance 35, 205 02 Malmö, Lund University, Sweden2Department of Clinical Sciences, Diabetes Epidemiology and Neuropathy Division, Entrance 51, 205 02 Malmö, Lund University, Sweden3deceased

BMC Gastroenterology 2007, 7:33doi:10.1186/1471-230X-7-33

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-230X/7/33

Received:

29 May 2007

Accepted:

14 August 2007

Published:

14 August 2007

© 2007 Ohlsson et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

We have previously demonstrated that patients with Crohn's disease (CD) of long duration have signs of autonomic neuropathy. The aim of this study was to examine whether autonomic neuropathy is an early manifestation of CD, or a sign appearing late in the course.

Methods

Twenty patients, median age 40 years, with a short duration of CD were included. Examination of autonomic reflexes included heart rate reaction to tilt (acceleration index – AI, brake index – BI) and heart rate variation to deep-breathing (expiration/inspiration index-E/I). Seven years later the same examinations were repeated, and in addition we examined the vasoconstriction response to indirect cooling by laser Doppler (vasoconstriction-index – VAC-index). The results were compared with healthy individuals.

Results

There was no difference in the blood pressure between controls and the patients with CD at rest, but eight minutes after tilt, the systolic blood pressure was lowered in patients compared to controls, both at the first assessment (p = 0.016) and after seven years (p = 0.042). The change in systolic blood pressure between rest and eight minutes after tilt was not significant at the first assessment, while a significant change compared to controls was observed seven years later (p = 0.028). This indicates a progressive dysfunction. There were no differences in E/I, AI, BI or VAC indexes between patients and controls.

Conclusion

Patients with CD suffer from autonomic neuropathy early in their disease, suggesting involvement of many different organ systems in this entity.