Introduction

In a patient with diabetes, gastrointestinal (GI) symptoms may be caused by the same spectrum of disorders as in the general population or by disturbances that arise as a complication of diabetes. The prevalence of GI symptoms in diabetics is not well-established, but appears to be substantially higher than in the general population. As many as 60-75% of patients visiting diabetes clinics report significant GI symptoms (1,2). Bytzer et al. (3) on the basis of a population-based survey of 15,000 adults, showed that the prevalence of a variety of upper and lower GI symptoms and symptom complexes in diabetics was increased. Interestingly, abnormalities in GI function, particularly motor function, are not invariably symptomatic. Annese et al. (4) studied esophageal, gastric, and gallbladder motor function in a group of patients with type 2 diabetes mellitus (most with autonomic neuropathy) and detected esophageal motor

From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ

abnormalities and delayed gastric emptying of solids in about 50% of the group, and impaired gallbladder emptying in two-thirds. In total, 74% of the patients had at least one of the three organs affected although, only 26% had all three involved. About two-thirds had GI symptoms, although these could not always be related to specific organ dysfunction. Sometimes even asymptomatic patients might show evidence of digestive tract dysfunction when tested (5), but again precise prevalence figures are not known because population-based studies have not been performed.

The pathogenesis of gut disturbances that arise as a complication of diabetes is likely to be multifactorial and is incompletely understood. In 1945, Rundles (6) recognized autonomic neuropathy as one of the etiological factors involved. However, other factors such as metabolic alterations (hyperglycemia, hypokalemia), vascular changes (microan-giopathy), altered hormonal control, and increased susceptibility to infections might play an important role. Primary smooth muscle dysfunction is considered unlikely, because motility is restored with parenterally administered prokinetic drugs such as erithromycin or metoclopramide (7).

From a pathophysiological standpoint, alterations in gut motor, secretory, and absorptive functions may be observed in the diabetic gut. Sometimes alteration of one of these functions predominates the others, but mixed disturbances are quite common. Furthermore, abnormal function, i.e., motility, might affect predominantly one region of the gut, manifesting itself clinically as a regional disturbance (Fig. 1). However, when the appropriate tests are performed, multiple levels of the gut are most often found to be affected. In this chapter the different levels of gut dysfunction that might occur in patients with diabetes will be described separately; however, this subdivision is adopted only for organizational purposes.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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