Neuropathy Gut Conditions (Enteric & Autonomic): A Clear, Patient-Friendly Guide

Neuropathy gut conditions happen when the nerves that control your digestive tract don’t work right. Doctors group these into autonomic neuropathies and enteric neuropathies. The result can be slow stomach emptying (gastroparesis), constipation, diarrhea, bloating, nausea, or swallowing problems. Diabetes is the leading cause worldwide, but autoimmune issues, infections, vitamin deficiencies, and certain medicines can also damage gut nerves. Diagnosis usually involves history, bloodwork, targeted imaging, and motility testing. Care focuses on treating the cause, reducing symptoms, improving nutrition and hydration, and rebuilding function with a team approach. Chiropractic integrative care can support posture, spinal and rib mobility, breathing mechanics, and overall nervous-system communication—important for comfort, function, and long-term resilience. (See sources: Stanford Health Care; NIDDK; Diabetologia; Cleveland Clinic; Mass General case study.) Advances+4Stanford Health Care+4NIDDK+4

What are enteric and autonomic neuropathies?

Your digestive system is lined with a huge network of nerves known as the enteric nervous system (ENS). It works with the autonomic nervous system (ANS) to move food, mix it with enzymes, absorb nutrients, regulate blood flow, and control gut reflexes—all without you thinking about it. When these nerves are damaged, gut function becomes irregular. Doctors call this problem enteric neuropathy (nerve injury inside the gut wall) or autonomic neuropathy (nerve injury in the automatic nerve pathways that control organs). Symptoms often include fullness, nausea, vomiting, reflux, bloating, constipation, diarrhea, or alternating bowel habits. NIDDK+2PMC+2

Why it matters: Timing and coordination are everything in digestion. When nerve signals slow down or misfire, the stomach or intestines can move too slowly (leading to gastroparesis or constipation) or too fast (leading to diarrhea). People may also feel pain, cramping, or early fullness after small meals. SpringerLink+1

The gut’s “second brain”: how it’s wired

The ENS contains millions of neurons and enteric glial cells. These cells help coordinate motility, protect the lining, and talk with the immune system. Newer research shows enteric glia actively regulate gut reflexes and help maintain the barrier that keeps germs and toxins out of your bloodstream. PMC+1
Glia–neuron crosstalk is a two-way street. When inflammation or infection hits, glia can change how nerves fire, which may speed up or slow down gut movements and affect symptoms. Frontiers
The microbiome (your gut bacteria) also “chats” with the ENS using chemical messengers. Changes in microbes and their metabolites can alter motility programs and nerve structure, which is one reason diet and antibiotics sometimes shift symptoms. Europe PMC

What causes neuropathy in the gut?

A. Diabetes (the most common cause)

Long-term high blood sugar injures small blood vessels and nerves that feed the gut. This can lead to gastroparesis, constipation, diarrhea, and bloating. Better glucose control can prevent worsening and sometimes improves symptoms. NIDDK+1

B. Autoimmune processes

In some people, the immune system targets nerve receptors or ion channels, changing motility and sensation. Autoantibodies and immune-mediated neuropathies can affect the enteric nervous system and the ANS. Frontiers+1

C. Infections and inflammation

Viral or bacterial illnesses can inflame gut nerves or glia, sometimes leading to dysmotility that lingers. Recent work links small-fiber neuropathy to changes in gut barrier integrity and immune balance, possibly via reduced neuropeptides and tight-junction disruption. Advances

Example: A recent study shows that T-cell attacks on enteric neurons and glia during West Nile virus infection can trigger intestinal dysmotility. Junior Chamber International

D. Nutritional deficits and malabsorption

Poor absorption—or low intake—of vitamins (like B12 or vitamin E) and minerals can damage nerves, including those controlling gut function. Treating the deficiency can help stop progression. PMC

E. Toxins, medicines, and chemotherapy

Chemotherapy and certain toxins can injure autonomic and peripheral nerves. People may notice numbness in hands/feet and new bowel symptoms. Wikipedia

F. Other contributors

Thyroid, kidney, or liver disease, autoimmune connective-tissue disease, and post-surgical changes can also affect gut nerve signaling or muscle response. advpainmd.com

What does it feel like? Common symptom patterns

Stomach (gastroparesis): Early fullness, nausea, vomiting of undigested food, bloating, poor appetite, weight changes. NIDDK
Small intestine: Bloating, abdominal distension, malabsorption, small intestinal bacterial overgrowth (SIBO) with gas or diarrhea. Cleveland Clinic
Colon/rectum: Constipation, diarrhea, or alternating bowel habits; urgency or accidents if rectal sensation/coordination are impaired. NIDDK
Esophagus: Trouble swallowing or food “sticking.” NIDDK

Symptoms can fluctuate day to day. Many patients also have lightheadedness, heart-rate changes, or sweating problems because autonomic nerves in other organs are affected too. NIDDK

How doctors diagnose neuropathy-related gut problems

Step 1: History and exam. Your clinician will map symptoms, diet, hydration, medicines, blood sugar, and weight changes. They’ll examine your abdomen and check for neuropathy elsewhere (feet, hands). NIDDK

Step 2: Bloodwork. Typical tests include glucose/A1c, thyroid, kidney/liver, B12, folate, vitamin E, iron studies, celiac screening, and markers of inflammation or autoimmunity when suspected. PMC+1

Step 3: Imaging and motility testing.

Gastric emptying scintigraphy (or breath testing) evaluates suspected gastroparesis. SpringerLink
Manometry and smart pill studies can assess small-bowel or colonic motility. SpringerLink
Autonomic testing may look at heart-rate and blood-pressure responses, sweat tests, and other measures when broader autonomic neuropathy is suspected. NIDDK
SIBO testing (breath tests) may be used with bloating, gas, or diarrhea plus risk factors for dysmotility. Cleveland Clinic

Advanced research links: In complex cases, doctors may explore barrier integrity (lactulose/mannitol tests) or small-fiber neuropathy with skin biopsy. Advances

Treatment: pairing cause-directed care with symptom relief

A. Address the driver

Diabetes: Tighten glucose, blood pressure, and lipids; this reduces further nerve damage and may steady gut function. NIDDK
Autoimmune: When clear immune targets exist, specialists may use immunotherapy. (This is highly individualized.) Frontiers
Deficiencies: Replete B12, vitamin E, thiamine, and others as indicated. PMC
Infections/SIBO: Treat appropriately; then support diet, hydration, and movement. Cleveland Clinic

B. Relieve symptoms and restore function

Gastroparesis: Smaller, softer meals; more liquids; consider low-fat/low-fiber in flares; prokinetic meds when appropriate; anti-nausea meds as needed. NIDDK
Constipation: Fluids, fiber (as tolerated), osmotic laxatives, stimulant laxatives short-term, pelvic-floor rehab if outlet dysfunction. NIDDK
Diarrhea: Hydration, electrolytes, antidiarrheals when appropriate, and evaluation for SIBO or malabsorption. NIDDK
Pain/bloating: Manage triggers, consider gentle activity, breathing drills, abdominal wall relaxation, and targeted medications when indicated. Cleveland Clinic

C. Team care matters
Neurogastroenterology centers stress combined medical, dietary, behavioral, and rehabilitative care because motility disorders are often multi-factorial. Cleveland Clinic

Where chiropractic integrative care can help

Chiropractic integrative care does not claim to “cure” enteric neuropathy. It supports a medical plan by improving the musculoskeletal foundations your nervous system uses every minute: posture, spinal and rib motion, breathing mechanics, and movement control. This can reduce pain, stiffness, and stress signals that often worsen gut symptoms, and it can help you stay active enough to follow diet and rehab plans. In practice, a plan may include:

Spinal manipulation and mobilization to improve thoracic and lumbar motion that supports rib motion and diaphragm function, which can relax abdominal wall tension and improve comfort with meals and activity.
Soft-tissue therapy for tight paraspinals, hip flexors, and diaphragm attachments that can provoke abdominal pressure or reflux discomfort.
Rehabilitation exercises for posture, core endurance, hip strength, and breathing re-training (nasal, diaphragmatic, low-tension exhales) to calm the stress response that aggravates symptoms.
Education and pacing so you can move daily without flare-ups and build resilience.

Dr. Alexander Jimenez’s clinic in El Paso integrates chiropractic care with nurse-practitioner medical assessment. His team uses advanced neuromusculoskeletal imaging (X-ray, MRI, ultrasound) when appropriate, then builds a plan that can include adjustments, medical co-management, guided exercise, and ergonomic or lifestyle changes. This dual-scope approach helps with both clinical care and accurate documentation (important for work, sports, personal, or motor-vehicle injuries). El Paso, TX Doctor Of Chiropractic+2El Paso, TX Doctor Of Chiropractic+2

Dr. Jimenez’s workflow in injury and complex cases (El Paso)

Intake & mapping

Timeline of symptoms (gut and non-gut), injury history, sleep, stress, diet, and meds.
Screen for red flags (GI bleeding, severe weight loss, persistent vomiting, dehydration).
Check for neuropathy signs in feet/hands and for posture/breathing patterns that raise abdominal pressure.

Dual-scope diagnosis

Medical side (APRN, FNP-BC): Orders labs (A1c, B12, thyroid, etc.), reviews meds, coordinates GI referrals and motility testing, and orders advanced imaging if needed.
Chiropractic side (DC): Examines spinal, rib, and pelvic motion, muscle tone, and breathing mechanics that may amplify pain or abdominal pressure. El Paso, TX Doctor Of Chiropractic

Plan & documentation

Clear goals: reduce pain and stiffness, improve meal tolerance and activity, restore sleep and stress control.
Records for insurers/attorneys when appropriate (MVA, workplace, or sports injuries), with imaging and functional testing attached to show progress over time. El Paso, TX Doctor Of Chiropractic

Rehab & re-checks

Progressive mobility and strength work.
Breathing drills and pacing strategies.
Regular outcome tracking (symptom logs, step counts, return-to-activity). El Paso, TX Doctor Of Chiropractic

Practical daily habits that support gut-nerve health

Eat smaller meals more often if you get full fast. Blend or soften foods during flares. Sip fluids across the day. (Gastroparesis-friendly eating helps many people.) NIDDK
Steady glucose if you have diabetes: monitor, move daily, and follow your medical plan. NIDDK
Gentle movement after meals (5–10 minutes) to help gas transit and reduce bloating. Cleveland Clinic
Nutrient check: Ask about B12, vitamin E, iron, and others if you have malabsorption or restricted diets. PMC
Breathing practice: 5 minutes of nasal, low-tension diaphragmatic breathing to calm the stress response that can amplify gut symptoms.
Sleep and stress: Prioritize a regular sleep window and short, daily stress breaks. Cleveland Clinic

When to seek urgent care

Call your clinician or urgent care now if you have:

Vomiting that won’t stop, signs of dehydration, or chest pain
Black or bloody stools, fever with severe abdominal pain, or unintentional rapid weight loss
Severe dizziness or fainting on standing (possible serious autonomic involvement) NIDDK

Bottom line

Neuropathy of the gut is real, common, and manageable. Most people do best with two tracks at once: treat the cause (like diabetes, immune, or nutritional issues) and rebuild comfort and function with a team plan. Chiropractic integrative care slots in as a supportive pillar—reducing musculoskeletal strain, improving breathing and movement, and helping you stay active enough to follow medical and nutritional therapy. In complex injury cases, Dr. Jimenez’s El Paso clinic pairs advanced imaging with a dual-scope (chiropractic + nurse-practitioner) approach and complete documentation to support both health and any legal needs. El Paso, TX Doctor Of Chiropractic+1

References

American National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Autonomic neuropathy. U.S. Department of Health & Human Services. NIDDK

Azpiroz, F., & Malagelada, C. (2016). Diabetic neuropathy in the gut: Pathogenesis and diagnosis. Diabetologia, 59(3), 404–408. SpringerLink

Cleveland Clinic. (2025). Dysmotility & motility disorders: Types & symptoms. Cleveland Clinic

Frontiers in Immunology. Bali, V., et al. (2024). Enteric glia as friends and foes of the intestinal epithelial barrier. Frontiers in Immunology. Frontiers

Massachusetts General Hospital—Pathways Case Record Team. (2022). Small fiber neuropathy and recurrent GI infections. Advances in Motion. Advances

Patankar, J. V., et al. (2025). Editorial: Enteric glia in intestinal homeostasis. Frontiers in Cellular Neuroscience. PMC

Pfeiffer, R. F. (2014). Neurologic manifestations of malabsorption syndromes. Handbook of Clinical Neurology, 621–632. PubMed

Stanford Health Care. (n.d.). Autonomic neuropathy: Gastrointestinal symptoms. (Accessed 2025). Stanford Health Care

Carlotta, S., et al. (2018). Peripheral neuropathy and gastroenterologic disorders. Acta Bio Medica. PMC

Camilleri, M. (2021). Gastrointestinal motility disorders in neurologic disease. Mayo Clinic Proceedings. PMC

Vicentini, F. A., et al. (2022). New concepts of the interplay between the gut microbiota and enteric nervous system. Microorganisms. Europe PMC

Cleveland Clinic. (n.d.). Peripheral neuropathy: What it is, symptoms & treatment. (Accessed 2025). Cleveland Clinic

Janova, H., et al. (2024). West Nile virus triggers intestinal dysmotility via T cell–dependent ENS injury. Journal of Clinical Investigation. Junior Chamber International

Kumar, A. (2025). The link between digestion problems and neuropathy. New Jersey Advanced Pain Management Center. advpainmd.com

Kornum, D. S., et al. (2021). Assessment of gastrointestinal autonomic dysfunction. Journal of Clinical Medicine. MDPI

About Dr. Alexander Jimenez’s integrative approach (El Paso)

Jimenez, A. (2025). Chiropractic and integrative care for drivers in El Paso. (Advanced neuromusculoskeletal imaging, dual-scope care.) El Paso, TX Doctor Of Chiropractic
Jimenez, A. (2025). Chiropractic emotional stress treatment and integrative care. (Imaging used to guide care and support legal documentation in injury cases.) El Paso, TX Doctor Of Chiropractic
Jimenez, A. (n.d.). Clinic home: Integrative chiropractic + medical insights. El Paso, TX Doctor Of Chiropractic

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for injuries or disorders affecting the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable attempt to provide supportive citations and identified relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.
Dr. Alex Jimenez, DC, MSACP, CCST, IFMCP, CIFM, ATN*
Email: coach@elpasofunctionalmedicine.com
Licensed in: Texas & New Mexico*

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