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Cited by 0Gastrointestinal motility and disordersCardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic Control

Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction

Shouman, Kamal, Camilleri, Michael, Singer, Wolfgang·2026·Autonomic Neuroscience
DOI 10.1016/j.autneu.2026.103474PMC PMC13618994
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Abstract

Gastrointestinal (GI) symptoms are frequent in disorders that involve the autonomic nervous system (ANS) or the enteric neuromuscular apparatus. Although dysfunction may occur anywhere along the alimentary tract, gastric manifestations are often the most clinically visible 'end-organ' expression of autonomic disease because they drive nausea, vomiting, early satiety, postprandial distress, malnutrition risk, and impaired drug absorption. In this invited review, we summarize the organization of the GI neuromuscular apparatus, emphasizing how intrinsic (enteric) circuitry and extrinsic sympathetic and parasympathetic pathways cooperate to regulate gastrointestinal functions. We then link common symptom clusters (dysphagia, gastroparesis, intestinal pseudo-obstruction, constipation, diarrhea, and fecal incontinence) to likely neuroanatomic levels and review autonomic test batteries and motility studies that help characterize dysfunction. Finally, we discuss neurologic and systemic diseases in which autonomic and enteric involvement produce prominent gastric and broader GI phenotypes. These include cerebrovascular and cortical neurodegenerative disorders, Parkinson's disease, structural and inflammatory brainstem syndromes, primary autonomic failure and hereditary dysautonomia, postural orthostatic tachycardia syndrome, spinal cord disorders (including multiple sclerosis), peripheral neuropathies such as diabetes mellitus and amyloidosis, paraneoplastic and autoimmune autonomic neuropathies, and selected neuromuscular and myopathic conditions.

AI snapshot

Written from the paper’s full text.

TL;DR

This invited narrative review summarizes how the intrinsic enteric nervous system and extrinsic sympathetic/parasympathetic pathways regulate gastrointestinal function, and how neurologic and systemic diseases disrupt them, with emphasis on gastric dysfunction as the most clinically visible end-organ expression of autonomic disease. It provides a practical framework linking symptom clusters to neuroanatomic levels and to autonomic and motility testing.

Key findings

  • Gastric manifestations (nausea, vomiting, early satiety, postprandial distress) are highlighted as the most clinically visible end-organ expression of autonomic disease because they also threaten nutrition and oral drug absorption; gastric motor dysfunction can impair levodopa pharmacokinetics and contribute to motor fluctuations in Parkinson disease.
  • Symptom clusters map onto neuroanatomic levels: oropharyngeal dysphagia (suprabulbar, lower motor neuron, neuromuscular junction, myopathy), esophageal dysphagia/reflux (vagal dysfunction, myopathy), gastric symptoms (delayed or accelerated emptying, impaired accommodation, pyloric dysfunction), and constipation/anorectal dysfunction (slow transit vs. evacuation disorders such as pelvic floor dyssynergia).
  • Disease-specific patterns are described, including prodromal GI dysmotility in Parkinson disease (with α-synuclein pathology potentially involving the ENS and vagal/brainstem nuclei early, and reduced PD risk after truncal vagotomy), area postrema syndrome with persistent nausea/vomiting in neuromyelitis optica spectrum disorder, and diabetic "autovagotomy" with loss of unmyelinated axons and interstitial cells of Cajal.
  • Reported quantitative figures include: chronic neurogenic bowel dysfunction in roughly 27%–62% of individuals after spinal cord injury, with gallstones in 17%–31% and only about half developing objective signs of "acute abdomen"; in a single-center retrospective cohort of 166 MS patients, delayed gastric emptying in 16% and accelerated emptying in 22%; approximately one-third of POTS patients reporting nausea, vomiting, bloating, or constipation; and in 10 patients with lipomatosis of nerve, 3 with early-onset colonic diverticulosis.

Methods

  • Design: invited narrative review, organized into sections on the GI neuromuscular apparatus and its intrinsic/extrinsic control, common GI symptom syndromes, autonomic and motility testing, and disease-specific sections (brain, brainstem, autonomic degenerations, spinal cord, peripheral neuropathy/systemic disorders, neuromuscular junction and myopathic disorders).
  • Data: no primary data collection; the paper synthesizes published literature and cites references throughout, including tables (Tables 1–4) summarizing extrinsic neural wiring, GI symptoms/syndromes with investigations, and autonomic function tests for parasympathetic and sympathetic impairment.
  • Main analysis: qualitative synthesis linking symptom clusters to likely neuroanatomic levels and to diagnostic tests, including cardiovagal, adrenergic, and sudomotor autonomic testing, pancreatic polypeptide response to modified sham feeding for vagal efferent integrity, and segmental motility studies (gastric emptying scintigraphy or breath testing, antroduodenal or colonic manometry, radiopaque marker/radionuclide/capsule transit testing, anorectal manometry with balloon expulsion and defecography).

Limitations

  • The paper states its goal is "not to provide exhaustive disease reviews, but rather to highlight high-yield clinical patterns, relevant mechanisms, and pragmatic diagnostic and treatment considerations," indicating deliberately selective rather than comprehensive coverage.
  • Evident from the text: as a narrative review without a stated systematic search strategy, inclusion of conditions and citations appears discretionary, and several cited findings rest on small or single-center studies (e.g., 12 patients in the HIV diarrhea crossover trial, 10 patients in the lipomatosis of nerve series, a single-center 166-patient MS cohort), which the paper does not appraise for quality or risk of bias.
  • Evident from the text: the referenced tables (Tables 1–4) are cited as containing key wiring, symptom, and autonomic test details but their content is not reproduced in the provided text, so those specifics cannot be verified here.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.autneu.2026.103474

Cites

155 of 155 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

61 of 169 cited sources checked · 29 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Advanced therapies can improve GI symptoms in selected patients with amyloidosis, including stem cell transplantation with cytotoxic therapy in systemic amyloidosis and liver transplantation in transthyretin amyloidosis.

    “Advanced therapies can improve GI symptoms in selected patients, including stem cell transplantation with cytotoxic therapy in systemic amyloidosis and liver transplantation in transthyretin amyloidosis (Afrough et al., 2015; Wixner et al., 2015).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Afrough et al., 2015 source
    • cites Wixner et al., 2015 source

      For the liver-transplantation part attributed to Wixner et al., the Results (GI symptoms; page not specified) report that GI symptom prevalence and scores increased after transplantation. The Conclusions say gastric emptying and nutritional status were maintained, but GI symptom scores increased—not improved. The stem-cell-transplantation part is attributed to the other citation and is not judged here. (LLM, conf=0.91)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Early screening and structured dysphagia management improve outcomes in acute stroke.

    “Early screening and structured dysphagia management improve outcomes (Arnold et al., 2016; Martino et al., 2005), and enteral feeding strategies may be needed when aspiration risk is high (Duncan et al., 2020; Geeganage et al., 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Arnold et al., 2016 source

      The Discussion (page unavailable) says regular dysphagia screening by trained therapists has been shown to decrease pneumonia in acute stroke patients, supporting an improvement in one outcome. It does not establish that early screening and structured dysphagia management broadly improve clinical outcomes; the study assessed associations between dysphagia and outcomes and calls for further research on management. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Martino et al., 2005 source
  • Premisecitation

    Objective measures of GI autonomic involvement have been correlated with central dopaminergic markers early in Parkinson disease.

    “Objective measures of GI autonomic involvement have been correlated with central dopaminergic markers early in disease (Hinkle et al., 2018), and GI symptoms often occur prior to motor diagnosis (Cersosimo et al., 2013; Fasano et al., 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hinkle et al., 2018 source

      The Results report that GI dysautonomia scores were associated with reduced caudate and putamen dopamine-transporter availability in early Parkinson disease. But the Methods describe GI involvement as measured by SCOPA-AUT questionnaire items, and the Discussion calls it a self-administered scale; the paper does not establish that the GI measures were objective. Page numbers were not available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    The gastrointestinal tract is increasingly viewed as a therapeutic target in Parkinson disease, including approaches that aim to modulate enteric neuronal signaling.

    “The gastrointestinal tract is also increasingly viewed as a therapeutic target in PD, including approaches that aim to modulate enteric neuronal signaling (Hauser et al., 2019).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hauser et al., 2019 source
  • Premisecitation

    Approximately one-third of patients with POTS report nausea, vomiting, bloating, or constipation.

    “Approximately one-third of patients report nausea, vomiting, bloating, or constipation (Low et al., 1994; Park et al., 2013).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Low et al., 1994 source
    • cites Park et al., 2013 source

      The Introduction reports that nearly 40% of adults with POTS have bloating, 25% have nausea, and smaller proportions have vomiting or constipation. It supports the claim that these symptoms occur in POTS, but does not establish that approximately one-third of patients report at least one of the listed symptoms. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • May combine two claims. 42
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Premisecitation

    Cholinesterase inhibitors can contribute to nausea, vomiting, diarrhea, and weight loss, and several studies have documented increased GI adverse events with these agents.

    “Cholinesterase inhibitors can contribute to nausea, vomiting, diarrhea, and weight loss, and several studies have specifically documented increased GI adverse events with these agents (Darreh-Shori et al., 2010; Farlow et al., 2011).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Darreh-Shori et al., 2010 source
    • cites Farlow et al., 2011 source

  • May combine two claims.

    Premisecitation

    Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management.

    “Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management (Chapin et al., 2020; Elbe et al., 2020; Toepfer et al., 1999; Toepfer et al., 1997).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Chapin et al., 2020 source
    • cites Elbe et al., 2020 source
    • cites Toepfer et al., 1999 source

      The Introduction mentions bulbar paresis, but the Discussion says participants swallowed the test meal within normal time limits; the study assesses gastric emptying rather than characterizing swallowing impairment. Searches for dysphagia, early recognition, and multidisciplinary management found no passage addressing those claims. The normal test-meal swallowing result does not contradict the broader claim about ALS. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    GI symptoms may predate motor features of Parkinson disease by years, consistent with the concept that α-synuclein pathology can involve the ENS and vagal/brainstem autonomic nuclei early in disease.

    “GI symptoms may predate motor features by years, consistent with the concept that α-synuclein pathology can involve the ENS and vagal/brainstem autonomic nuclei early in disease (Rietdijk et al., 2017; Travagli et al., 2020).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Rietdijk et al., 2017 source

      The “Preclinical and Clinical Evidence” section says digestive complaints can occur before motor symptoms and reports Lewy pathology in the ENS. The “Enteric Route: αSyn Spreading via Vagal Nerve” section describes pathology in the vagal nerve and dorsal motor nucleus of the vagus early in the proposed progression. The copy does not specify that GI symptoms precede motor features by years; no page numbers are available in the indexed passages. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Travagli et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Enteral feeding strategies may be needed when aspiration risk is high in acute stroke.

    “Early screening and structured dysphagia management improve outcomes (Arnold et al., 2016; Martino et al., 2005), and enteral feeding strategies may be needed when aspiration risk is high (Duncan et al., 2020; Geeganage et al., 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Duncan et al., 2020 source

      The Discussion (page unavailable) mentions tube-feeding cessation in studies of tracheostomised acute stroke patients, and the Introduction discusses aspiration as a symptom of dysphagia. The paper does not say that high aspiration risk is an indication for enteral feeding or recommend an enteral feeding strategy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites Geeganage et al., 2012 source

  • May combine two claims.

    Premisecitation

    Large epidemiologic studies suggest that truncal vagotomy is associated with a reduced risk of subsequent Parkinson disease, supporting a potential gut-brain contribution to pathogenesis.

    “Large epidemiologic studies also suggest that truncal vagotomy is associated with a reduced risk of subsequent PD, supporting a potential gut–brain contribution to pathogenesis (Liu et al., 2017).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Liu et al., 2017 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Distinguishing slow-transit constipation from evacuation disorders (e.g., pelvic floor dyssynergia) is a useful first step because confirmatory tests and treatment strategies differ.

    “A useful first step is to distinguish slow-transit constipation from evacuation disorders (e.g., pelvic floor dyssynergia), because confirmatory tests and treatment strategies differ (Manabe et al., 2010; Metcalf et al., 1987).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Manabe et al., 2010 source

      The Discussion (page unavailable) says colonic-transit measurements may guide further diagnostic tests and the choice of therapy, including prokinetics for patients with delayed transit. It does not discuss distinguishing slow-transit constipation from evacuation disorders or specify different confirmatory tests and treatments for those disorders. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Metcalf et al., 1987 source

  • May combine two claims.

    Premisecitation

    Sialorrhea in Parkinson disease can be managed pharmacologically with anticholinergics such as glycopyrrolate or scopolamine, although these medications can have negative effects on other aspects of gastrointestinal function; alternatively, botulinum toxin injections can be very effective and are less likely to have negative systemic effects.

    “Sialorrhea can be managed pharmacologically with anticholinergics such as glycopyrrolate or scopolamine, although these medications can have negative effects on other aspects of gastrointestinal function; alternatively, botulinum toxin injections can be very effective and are less likely to have negative systemic effects (Seppi et al., 2011).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Seppi et al., 2011 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bulbar dysfunction and dysphagia have been described in post-polio syndromes, where chronic neuromuscular weakness and impaired coordination can compromise safe swallowing and nutrition.

    “Bulbar dysfunction and dysphagia have also been described in post-polio syndromes, where chronic neuromuscular weakness and impaired coordination can compromise safe swallowing and nutrition (Kay et al., 2018; Oluwasanmi et al., 2019).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Kay et al., 2018 source
    • cites Oluwasanmi et al., 2019 source

      The Clinical Manifestations > Dysphagia section links bulbar-muscle involvement to swallowing difficulty, aspiration risk, and nutritional problems. Management of Postpolio Syndrome also says laryngeal and esophageal muscle weakness can cause dysphagia. The copy does not specifically identify impaired coordination as a contributing mechanism; page numbers were not provided. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Familial dysautonomia is a hereditary sensory and autonomic neuropathy in which feeding and GI motor problems are often present from infancy.

    “Familial dysautonomia is a hereditary sensory and autonomic neuropathy in which feeding and GI motor problems are often present from infancy (Rubin et al., 2017).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Rubin et al., 2017 source

      The Introduction describes familial dysautonomia as a congenital sensory and autonomic neuropathy, and The FD phenotype identifies it as a hereditary sensory and autonomic neuropathy with typical swallowing difficulty and gastrointestinal dysfunction. The copy does not establish that feeding and GI motor problems are often present from infancy, or specifically characterize the GI dysfunction as a motor problem. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In neuromyelitis optica spectrum disorder, persistent nausea and vomiting due to area postrema involvement is a well-described 'area postrema syndrome' and should prompt neurologic evaluation in appropriate contexts.

    “In neuromyelitis optica spectrum disorder, persistent nausea and vomiting due to area postrema involvement is a well-described ‘area postrema syndrome’ and should prompt neurologic evaluation in appropriate contexts (Popescu et al., 2011).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Popescu et al., 2011 source

  • May combine two claims.

    Premisecitation

    Pure autonomic failure is a chronic neurogenic autonomic disorder in which gastrointestinal involvement may include constipation and other manifestations of dysmotility.

    “Pure autonomic failure (PAF) is a chronic neurogenic autonomic disorder in which gastrointestinal involvement may include constipation and other manifestations of dysmotility (Sakakibara et al., 2000; Thatcher et al., 1987; Yamanaka et al., 2006).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Sakakibara et al., 2000 source
    • cites Thatcher et al., 1987 source
    • cites Yamanaka et al., 2006 source

  • May combine two claims.

    Premisecitation

    Neuropathologic overlap between pure autonomic failure and Lewy body disorders and multiple system atrophy has been described, supporting close longitudinal clinical surveillance.

    “Neuropathologic overlap with Lewy body disorders and multiple system atrophy has been described, supporting close longitudinal clinical surveillance (Hague et al., 1997; Singer et al., 2021).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Hague et al., 1997 source
    • cites Singer et al., 2021 source

      The Discussion (page unavailable) describes Lewy body pathology in autopsy reports of patients with pure autonomic failure and calls for continued surveillance. The Results, under “Follow-up and Phenoconversion” (page unavailable), report conversion to multiple system atrophy, confirmed at autopsy in two patients, but do not establish neuropathologic overlap between pure autonomic failure and multiple system atrophy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    POTS may co-occur with hypermobility-type Ehlers-Danlos syndrome, fibromyalgia, chronic fatigue, interstitial cystitis, and functional GI disorders.

    “POTS may co-occur with hypermobility-type Ehlers–Danlos syndrome, fibromyalgia, chronic fatigue, interstitial cystitis (DiBaise et al., 2018), and functional GI disorders (Tai et al., 2020).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites DiBaise et al., 2018 source
    • cites Tai et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Newer disease-modifying therapies, including antisense oligonucleotides and RNA interference approaches, are increasingly used for hereditary transthyretin amyloidosis.

    “Newer disease-modifying therapies, including antisense oligonucleotides and RNA interference approaches, are increasingly used for hereditary transthyretin amyloidosis (Gertz et al., 2019).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Gertz et al., 2019 source

      The Abstract Introduction identifies inotersen as an antisense oligonucleotide and patisiran as an RNA interference therapy. The Therapeutic landscape for ATTR section says both recently received marketing authorization for hereditary ATTR neuropathy and have demonstrated efficacy. The review does not establish that their clinical use was increasing. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reviews of adult myositis emphasize the spectrum of esophageal and intestinal complications.

    “Juvenile dermatomyositis has been associated with novel GI tract manifestations (Laskin et al., 1999), and reviews of adult myositis emphasize the spectrum of esophageal and intestinal complications (Ebert, 2010).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Ebert, 2010 source

  • May combine two claims.

    Premisecitation

    Experimental immunization with neuronal nicotinic acetylcholine receptors can reproduce autonomic and GI dysfunction in animal models, supporting a pathogenic role for some antibody-mediated processes.

    “Experimental immunization with neuronal nicotinic acetylcholine receptors can reproduce autonomic and GI dysfunction in animal models, supporting a pathogenic role for some antibody-mediated processes (Lennon et al., 2003).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lennon et al., 2003 source

  • May combine two claims.

    Premisecitation

    NF1 patients can develop a range of intra-abdominal tumors, including plexiform neurofibromas, malignant peripheral nerve sheath tumors, gastrointestinal stromal tumors related to interstitial cells of Cajal hyperplasia, neuroendocrine tumors, and embryonal tumors such as rhabdomyosarcoma.

    “NF1 patients can develop a range of intra-abdominal tumors, including plexiform neurofibromas, malignant peripheral nerve sheath tumors, gastrointestinal stromal tumors related to interstitial cells of Cajal hyperplasia, neuroendocrine tumors, and embryonal tumors such as rhabdomyosarcoma (Dare et al., 2020; Xie et al., 2018).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Dare et al., 2020 source
    • cites Xie et al., 2018 source

      The Introduction (page unavailable) says NF1 can be associated with stromal and neuroendocrine tumors, and the case report documents rectal neuroendocrine tumors. Our copy does not identify plexiform neurofibromas, malignant peripheral nerve sheath tumors, interstitial cells of Cajal hyperplasia, or rhabdomyosarcoma as part of the claimed range. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Neurologic immune-related adverse events from immune checkpoint inhibitors include autonomic neuropathy and can present with severe GI dysmotility.

    “Neurologic immune-related adverse events from immune checkpoint inhibitors include autonomic neuropathy and can present with severe GI dysmotility (Bertrand et al., 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bertrand et al., 2015 source

      The Results (‘Other irAEs’; page unavailable) describe neurologic immune-related adverse events associated with anti-CTLA-4 treatment. The References (page unavailable) include cases of ipilimumab-associated enteric neuropathy with occlusion or severe constipation, supporting the GI-dysmotility aspect. The paper does not explicitly call these cases autonomic neuropathy, and its review concerns anti-CTLA-4 antibodies rather than immune checkpoint inhibitors generally. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Gastric symptoms rarely occur in isolation; the same disease processes often affect esophageal, bowel, and anorectal function and may coexist with orthostatic intolerance, sweating abnormalities, urinary dysfunction, or neuropathic pain.

    “At the same time, gastric symptoms rarely occur in isolation; the same disease processes often affect esophageal, bowel, and anorectal function and may coexist with orthostatic intolerance, sweating abnormalities, urinary dysfunction, or neuropathic pain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prevertebral ganglia integrate visceral afferent information and participate in local reflex arcs, including inhibitory enteroenteric reflexes that coordinate activity across segments.

    “Prevertebral ganglia integrate visceral afferent information and participate in local reflex arcs, including inhibitory enteroenteric reflexes that coordinate activity across segments (Kreulen et al., 1979; Langley et al., 1895; Szurszewski et al., 1984) (Fig. 2).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kreulen et al., 1979 source
    • cites Langley et al., 1895

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Szurszewski et al., 1984

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    When GI circuits are disrupted by neurologic or systemic disease, symptoms commonly cluster around motor dysfunction rather than occurring as isolated sensory or secretory complaints.

    “When these circuits are disrupted by neurologic or systemic disease, symptoms commonly cluster around motor dysfunction (dysphagia, impaired gastric emptying, pseudo-obstruction, constipation, or incontinence) rather than occurring as isolated sensory or secretory complaints.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Extrinsic parasympathetic innervation reaches the upper gastrointestinal tract mainly through the vagus nerve, while sacral outflow supplies the distal colon and anorectum, generally with excitatory effects on non-sphincteric muscle and propulsion.

    “Extrinsic parasympathetic innervation reaches the upper gastrointestinal tract mainly through the vagus nerve, while sacral outflow supplies the distal colon and anorectum, generally with excitatory effects on non-sphincteric muscle and propulsion.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Camilleri, 1997

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Gastric manifestations are often the most clinically visible end-organ expression of autonomic disease because they drive nausea, vomiting, early satiety, postprandial distress, malnutrition risk, and impaired drug absorption.

    “Although dysfunction may occur anywhere along the alimentary tract, gastric manifestations are often the most clinically visible ‘end-organ’ expression of autonomic disease because they drive nausea, vomiting, early satiety, postprandial distress, malnutrition risk, and impaired drug absorption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Sympathetic control arises from thoracolumbar segments via prevertebral ganglia; in most regions it inhibits propulsive smooth muscle activity and enhances sphincter tone, acting as a functional 'brake' on transit.

    “Sympathetic control arises from thoracolumbar segments via prevertebral ganglia; in most regions it inhibits propulsive smooth muscle activity and enhances sphincter tone, acting as a functional ‘brake’ on transit.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Camilleri, 1997

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Chronic intestinal pseudo-obstruction occupies an important middle ground between focal and diffuse neuromuscular disease: patients appear obstructed clinically and radiographically, but mechanical causes are absent and the underlying mechanism may be neuropathic, myopathic, or mixed.

    “Chronic intestinal pseudo-obstruction occupies an important middle ground between focal and diffuse neuromuscular disease: patients appear obstructed clinically and radiographically, but mechanical causes are absent and the underlying mechanism may be neuropathic, myopathic, or mixed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    A system-based autonomic testing approach allows for assessment of distribution and severity of autonomic failure, can help localize dysfunction to preganglionic versus postganglionic pathways, and can support broader diagnostic evaluation when autonomic impairment is widespread.

    “This system-based approach allows for the assessment of distribution and severity of autonomic failure, can help localize dysfunction to preganglionic versus postganglionic pathways, and can support broader diagnostic evaluation when autonomic impairment is widespread.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    More widespread autonomic dysfunction is common in dementia with Lewy bodies, adding another cause for GI symptoms akin to those in Parkinson's disease.

    “More widespread autonomic dysfunction is common in dementia with Lewy bodies adding another cause for GI symptoms akin to those discussed in more detail in the following section on Parkinson’s disease, another synucleinopathy (Thaisetthawatkul et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Thaisetthawatkul et al., 2004 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Integrating segmental motility measurements with autonomic testing can clarify whether symptoms reflect isolated enteric disease, extrinsic autonomic denervation, or combined neuromuscular pathology.

    “In clinical practice, integrating segmental motility measurements with autonomic testing can clarify whether symptoms reflect isolated enteric disease, extrinsic autonomic denervation, or combined neuromuscular pathology.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Disruption of vagal circuits, enteric inhibitory pathways, or pyloric control can present with similar symptoms despite distinct mechanisms.

    “Disruption of vagal circuits, enteric inhibitory pathways, or pyloric control can therefore present with similar symptoms despite distinct mechanisms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Esophageal dysphagia and reflux symptoms may reflect vagal dysfunction, esophageal myopathy, or primary esophageal motor disorders and warrant endoscopic and high-resolution manometric evaluation.

    “Esophageal dysphagia and reflux symptoms may reflect vagal dysfunction, esophageal myopathy, or primary esophageal motor disorders and warrant endoscopic and high-resolution manometric evaluation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Randomized controlled trials have demonstrated benefit of polyethylene glycol 3350 and lubiprostone in Parkinson disease-related constipation.

    “Randomized controlled trials have demonstrated benefit of polyethylene glycol 3350 (Zangaglia et al., 2007) and lubiprostone (Ondo et al., 2012) in PD-related constipation, and dopaminergic agents such as apomorphine can influence defecatory function (Edwards et al., 1993b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Zangaglia et al., 2007 source
    • cites Ondo et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Gastric symptoms such as early satiety, postprandial fullness, nausea, and vomiting may reflect delayed emptying (gastroparesis), impaired accommodation, pyloric dysfunction, or, less commonly, accelerated gastric emptying.

    “Gastric symptoms such as early satiety, postprandial fullness, nausea, and vomiting may reflect delayed emptying (gastroparesis), impaired accommodation, pyloric dysfunction, or, less commonly, accelerated gastric emptying.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Constipation after stroke is common and is driven by a combination of reduced mobility, impaired cortical control of defecatory reflexes, medication effects, and autonomic imbalance.

    “Constipation after stroke is common and is driven by a combination of reduced mobility, impaired cortical control of defecatory reflexes, medication effects, and autonomic imbalance (Cheng et al., 2020; Li et al., 2017; Yi et al., 2011).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Cheng et al., 2020 source
    • cites Li et al., 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Yi et al., 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Acute colonic pseudo-obstruction has been described in the setting of stroke.

    “Acute colonic pseudo-obstruction has also been described in the setting of stroke (Reynolds et al., 1977).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Reynolds et al., 1977 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Loss or dysfunction of pacemaker/intermediary cells, together with enteric neuropathy or myopathy, can produce gastric dysrhythmias, impaired accommodation, pyloric dysfunction, and delayed or rapid emptying.

    “Loss or dysfunction of these cells, together with enteric neuropathy or myopathy, can produce gastric dysrhythmias, impaired accommodation, pyloric dysfunction, and delayed or rapid emptying.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Gastric motor dysfunction can impair levodopa pharmacokinetics and contribute to motor fluctuations in Parkinson disease.

    “Gastric motor dysfunction can impair levodopa pharmacokinetics and contribute to motor fluctuations (Pfeiffer et al., 2020); systematic reviews support the association between PD and gastroparesis (Heetun et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pfeiffer et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Oropharyngeal dysphagia is a high-stakes symptom because it increases aspiration risk and can limit nutrition and hydration.

    “Oropharyngeal dysphagia is a high-stakes symptom because it increases aspiration risk and can limit nutrition and hydration.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In acute spinal cord injury, "acute abdomen" may present atypically: patients may exhibit vague or poorly localized abdominal pain, vomiting, or agitation, and only about half develop objective signs such as focal tenderness, fever, or leukocytosis.

    “Importantly, “acute abdomen” in this population may present atypically: instead of guarding or absent bowel sounds, patients may exhibit vague or poorly localized abdominal pain, vomiting, or agitation, and only about half develop objective signs such as focal tenderness, fever, or leukocytosis (Ebert, 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ebert, 2012

  • May combine two claims.

    Premisecitation

    Persistent upper gastrointestinal motility problems are relatively uncommon in the chronic phase of spinal cord injury, whereas colonic and anorectal dysfunction predominate, reflecting loss of supraspinal modulation of sacral parasympathetic outflow and impaired postprandial colonic motor responses.

    “Persistent upper gastrointestinal motility problems are relatively uncommon in the chronic phase, whereas colonic and anorectal dysfunction predominate, reflecting loss of supraspinal modulation of sacral parasympathetic outflow and impaired postprandial colonic motor responses (Bruninga et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bruninga et al., 1997

  • May combine two claims.

    Premisecitation

    Common features of familial dysautonomia include oropharyngeal incoordination, poor suck, excessive drooling, gastroesophageal reflux, and episodic vomiting that is often triggered by physical or emotional stress.

    “Common features include oropharyngeal incoordination, poor suck, excessive drooling, gastroesophageal reflux, and episodic vomiting that is often triggered by physical or emotional stress (Krausz et al., 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Krausz et al., 1994 source

  • May combine two claims.

    Premisecitation

    Structural and functional abnormalities in familial dysautonomia include reduced neuronal density in the myenteric plexus and severe esophageal dysmotility with dilatation and fluid stasis in some patients.

    “Structural and functional abnormalities include reduced neuronal density in the myenteric plexus (Bar-Shai et al., 2004) and severe esophageal dysmotility with dilatation and fluid stasis in some patients (Palma et al., 2018).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Bar-Shai et al., 2004 source
    • cites Palma et al., 2018 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    POTS is characterized by an exaggerated heart rate rise with upright posture in the absence of orthostatic hypotension.

    “It is characterized by an exaggerated heart rate rise with upright posture in the absence of orthostatic hypotension (Schondorf et al., 1993).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Schondorf et al., 1993 source

  • May combine two claims.

    Premisecitation

    Esophageal and gastric transit may be delayed in familial dysautonomia, which can contribute to recurrent aspiration pneumonia.

    “Esophageal and gastric transit may be delayed, which can contribute to recurrent aspiration pneumonia (Krausz et al., 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Krausz et al., 1994 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    When brainstem symptoms are accompanied by more widespread autonomic deficits, particularly combined vagal and preganglionic sympathetic involvement suggested by anhidrosis on thermoregulatory sweat testing with preserved postganglionic responses on QSART, neuroimaging and broader evaluation for central nervous system lesions are warranted.

    “When brainstem symptoms are accompanied by more widespread autonomic deficits, particularly combined vagal and preganglionic sympathetic involvement suggested by anhidrosis on thermoregulatory sweat testing with preserved postganglionic responses on quantitative sudomotor axon reflex testing (QSART), neuroimaging and broader evaluation for central nervous system lesions are warranted (Tables 3 and”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Chronic neurogenic bowel dysfunction is common, reported in roughly 27%-62% of individuals following spinal cord injury, and most often manifests as constipation, bloating, abdominal discomfort, rectal bleeding, hemorrhoids, fecal incontinence, and episodes of autonomic hyperreflexia; gallstones are also frequent (17%-31%).

    “By contrast, chronic neurogenic bowel dysfunction is common, reported in roughly 27%–62% of individuals following spinal cord injury, and most often manifests as constipation, bloating, abdominal discomfort, rectal bleeding, hemorrhoids, fecal incontinence, and episodes of autonomic hyperreflexia; gallstones are also frequent (17%–31%) (Ebert, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ebert, 2012

  • May combine two claims.

    Interpretationnone given

    Gastric emptying abnormalities are not central features in ALS, but reduced mobility, respiratory compromise, and medication effects can contribute to constipation and feeding difficulties.

    “Gastric emptying abnormalities are not central features, but reduced mobility, respiratory compromise, and medication effects can contribute to constipation and feeding difficulties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Acute spinal cord injury can be accompanied by transient disturbances of upper gastrointestinal motility, including dysphagia; ileus and acalculous cholecystitis have also been described, particularly after acute cervical injury.

    “Acute spinal cord injury can be accompanied by transient disturbances of upper gastrointestinal motility, including dysphagia; ileus and acalculous cholecystitis have also been described, particularly after acute cervical injury (Wolf et al., 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolf et al., 2003 source

  • May combine two claims.

    Premisecitation

    Pathologic correlates of diabetic GI dysfunction include autovagotomy, loss of unmyelinated axons, and loss of interstitial cells of Cajal.

    “Pathologic correlates include ‘autovagotomy’ (loss of unmyelinated axons) and loss of interstitial cells of Cajal, with emerging evidence that macrophage phenotypes within the gut wall influence susceptibility to oxidative stress (Camilleri et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Camilleri et al., 2018 source

  • May combine two claims.

    Premisecitation

    Diabetes can affect motility along the entire gut, producing gastroparesis often with antral hypomotility and pyloric dysfunction, rapid gastric emptying, impaired gastric accommodation, diarrhea, constipation, and fecal incontinence.

    “Diabetes can affect motility along the entire gut, producing gastroparesis (often with antral hypomotility and pyloric dysfunction), rapid gastric emptying, impaired gastric accommodation, diarrhea, constipation, and fecal incontinence (Camilleri et al., 2018; Chedid et al., 2019).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Camilleri et al., 2018 source
    • cites Chedid et al., 2019 source

  • May combine two claims.

    Premisecitation

    Among NF1 patients with motility testing, abnormalities included esophageal achalasia or spasm, delayed gastric emptying, slow-transit constipation, and pelvic floor dyssynergia.

    “Among those with motility testing, abnormalities included esophageal achalasia/spasm, delayed gastric emptying, slow-transit constipation, and pelvic floor dyssynergia; histopathology suggested enteric neuropathic mechanisms in some cases (Damianos et al., 2025).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Damianos et al., 2025 source

  • May combine two claims.

    Premisecitation

    In one case of lipomatosis of nerve, postprandial colonic motor activity was reduced, while pharmacologic stimulation with intravenous neostigmine remained intact; myenteric neuronal morphology was reported to be normal.

    “In one case, postprandial colonic motor activity was reduced, while pharmacologic stimulation with intravenous neostigmine remained intact; myenteric neuronal morphology was reported to be normal.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Marek et al., 2020 source

  • May combine two claims.

    Premisecitation

    Constipation is frequent in children with neurofibromatosis type 1 and can be associated with increased rectal diameter and prolonged colonic transit.

    “Constipation is frequent in children with neurofibromatosis type 1 (NF1) and can be associated with increased rectal diameter and prolonged colonic transit (Pedersen et al., 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pedersen et al., 2013 source

  • May combine two claims.

    Premisecitation

    In acute intermittent porphyria, neurovisceral attacks may mimic surgical abdomen and can be accompanied by ileus or pseudo-obstruction, reflecting autonomic neuropathy and visceral motor dysfunction.

    “In acute intermittent porphyria, neurovisceral attacks may mimic surgical abdomen and can be accompanied by ileus or pseudo-obstruction, reflecting autonomic neuropathy and visceral motor dysfunction (Berlin et al., 1950; Stein et al., 1970; Stolzel et al., 2019).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Berlin et al., 1950 source
    • cites Stein et al., 1970 source
    • cites Stolzel et al., 2019 source
    • Rests on an assumption: Acute hepatic porphyrias can present with severe abdominal pain, nausea, constipation, and autonomic instability.

  • May combine two claims.

    Premisecitation

    Guillain-Barré syndrome can feature prominent dysautonomia, and there are reports of associations with gastrointestinal infections such as Helicobacter pylori.

    “Guillain–Barré syndrome can feature prominent dysautonomia, and there are reports of associations with gastrointestinal infections such as Helicobacter pylori (Dardiotis et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dardiotis et al., 2020 source

  • May combine two claims.

    Interpretationreasoning

    Disease-specific patterns, such as prodromal dysmotility in Parkinson disease, area postrema syndromes, diabetic autovagotomy, and antibody-mediated enteric neuropathy, provide additional diagnostic clues and may guide treatment.

    “Disease-specific patterns, such as prodromal dysmotility in Parkinson disease, area postrema syndromes, diabetic ‘autovagotomy,’ and antibody-mediated enteric neuropathy, provide additional diagnostic clues and may guide treatment.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    Gastrointestinal symptoms are frequent in disorders that involve the autonomic nervous system or the enteric neuromuscular apparatus.

    “Gastrointestinal (GI) symptoms are frequent in disorders that involve the autonomic nervous system (ANS) or the enteric neuromuscular apparatus.”

  • The paper relies on this without support.

    The enteric nervous system can generate patterned behaviors such as peristalsis and the migrating motor complex with a high degree of autonomy, largely independent of extrinsic neural control.

    “Through sensory neurons, interneurons, and motor/secretomotor neurons, the ENS can generate patterned behaviors such as peristalsis and the migrating motor complex with a high degree of autonomy. Thus, such patterns of motor function are largely independent of extrinsic neural control.”

  • The paper relies on this without support.

    Constipation and anorectal dysfunction are among the most frequent gastrointestinal manifestations of neurologic disease.

    “Constipation and anorectal dysfunction are among the most frequent GI manifestations of neurologic disease.”

  • The paper relies on this without support.

    Gastrointestinal complaints are common in the general population and most often arise from primary GI disorders rather than neurologic disease.

    “GI complaints are common in the general population and most often arise from primary GI disorders rather than neurologic disease.”

  • The paper relies on this without support.

    Swallowing impairment is a well-recognized complication of acute stroke and contributes to aspiration pneumonia and poor nutritional status.

    “Swallowing impairment is a well-recognized complication of acute stroke and contributes to aspiration pneumonia and poor nutritional status.”

  • The paper relies on this without support.

    Parkinson disease is a prototypical neurologic disorder in which autonomic and enteric pathology contributes substantially to morbidity.

    “Parkinson disease (PD) is a prototypical neurologic disorder in which autonomic and enteric pathology contributes substantially to morbidity.”

  • The paper relies on this without support.

    The brainstem contains key integrative circuits for autonomic regulation of the stomach and upper gut.

    “The brainstem contains key integrative circuits for autonomic regulation of the stomach and upper gut.”

  • The paper relies on this without support.

    POTS is a form of orthostatic intolerance that is particularly common in younger women.

    “Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance that is particularly common in younger women.”

  • The paper relies on this without support.

    Delayed recognition of an intra-abdominal emergency in spinal cord injury can contribute to excess mortality.

    “Delayed recognition of an intra-abdominal emergency in this setting can contribute to excess mortality.”

  • The paper relies on this without support.

    Disruption of coordinated pelvic floor and anal sphincter function contributes to defecatory disorders and incontinence in spinal cord injury.

    “Disruption of coordinated pelvic floor and anal sphincter function further contributes to defecatory disorders and incontinence.”

  • The paper relies on this without support.

    Multiple sclerosis is frequently accompanied by autonomic dysregulation.

    “Multiple sclerosis (MS) is frequently accompanied by autonomic dysregulation, and bowel symptoms are common across disease phenotypes.”

  • The paper relies on this without support.

    Demyelinating lesions involving spinal long tracts and autonomic centers can disrupt colonic propulsion, anorectal sensation, and pelvic floor coordination in multiple sclerosis.

    “Physiologically, demyelinating lesions involving spinal long tracts and autonomic centers can disrupt colonic propulsion, anorectal sensation, and pelvic floor coordination.”

  • The paper relies on this without support.

    Gastrointestinal dysfunction in amyloidosis may result from mucosal infiltration, neuromuscular infiltration, and/or extrinsic autonomic neuropathy.

    “Gastrointestinal dysfunction in amyloidosis may result from mucosal infiltration, neuromuscular infiltration, and/or extrinsic autonomic neuropathy.”

  • The paper relies on this without support.

    Amyloid neuropathy may cause dysphagia, constipation, diarrhea, and steatorrhea, besides sensorimotor and cardiovascular autonomic deficits.

    “Clinically, amyloid neuropathy, besides sensorimotor and cardiovascular autonomic deficits, may cause dysphagia, constipation, diarrhea, and steatorrhea.”

  • The paper relies on this without support.

    Acute hepatic porphyrias can present with severe abdominal pain, nausea, constipation, and autonomic instability.

    “Acute hepatic porphyrias can present with severe abdominal pain, nausea, constipation, and autonomic instability.”

  • The paper relies on this without support.

    Chronic peripheral neuropathy is the most prevalent neurologic substrate for GI motor dysfunction.

    “Chronic peripheral neuropathy is the most prevalent neurologic substrate for GI motor dysfunction.”

  • The paper relies on this without support.

    GI symptoms are common and nonspecific.

    “Because GI symptoms are common and nonspecific, identifying a neurogenic mechanism requires careful pattern recognition and attention to accompanying autonomic and neurologic features.”
17 of 17

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Authors
Shouman, K., Camilleri, M., & Singer, W.
Affiliations
Mayo Clinic (US)
Corresponding author
Singer, Wolfgang
ORCID
Venue
Autonomic Neuroscience
Publisher
Elsevier BV
Published
2026-12
Volume
268
Pages
103474
ISSN
1566-0702 (ISSN-L)
DOI
10.1016/j.autneu.2026.103474
PMC
PMC13618994
OpenAlex
W7204518322
Semantic Scholar
45d37d22739fc178c5f4f3d917cfeae223352673
Cited by
0
References
155
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Autonomic Neuroscience (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Michael J Fox Foundation for Parkinson's Research
  • US Food and Drug Administration (R01 FD07290)
  • NIH (R01NS92625, R01NS126406, R01DK135540)
  • Mayo Foundation for Medical Education and Research
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
autonomic nervous system, gastrointestinal dysfunction, gastric dysfunction, enteric nervous system, gastrointestinal motility, gastroparesis, intestinal pseudo-obstruction, dysphagia, constipation, diarrhea, fecal incontinence, autonomic function testing, Parkinson's disease, primary autonomic failure, postural orthostatic tachycardia syndrome, multiple sclerosis, diabetic neuropathy, amyloidosis, neuromuscular disorders, cerebrovascular disease, neurodegenerative diseases, brainstem syndrome

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-22.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-22.

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