Brain changes in diabetes mellitus patients with gastrointestinal symptoms

Figure 2 Schematic representation of the possible nerve pathways and mechanisms that theoretical can contribute to gastrointestinal symptoms in diabetics. (1) Vascular and degenerative changes in the enteric nervous system; Autonomic neuropathy affecting (2) the vagal nerve and (3) sympathetic pathways; (4) Affection of visceral (and somatic in case the peritoneum is involved) afferents mediating sensations such as pain; (5) Structural and functional changes in the brain (and spinal cord), together with (6) affection of spino-bulbo-spinal loops.