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Diabetes mellitus is a condition that might result in a variety of derangements of gastrointestinal (GI) structure and function. Disturbances may manifest as symptoms and metabolic changes that in turn, might impich in the management of the patient with diabetes. The present chapter describes the pathophysiology, clinical findings, and management options dealing with the main clinical syndromes associated with disturbances of GI physiology in diabetics. It deals with esophageal dysfunction, sometimes subclinical, but often a source of bothersome upper GI symptoms and also, describes the gastroparesis syndrome, arguably the most characteristic form of gas-troduodenal dysfunction in the diabetic. It deals as well with the complex issue of diarrhea in the diabetic patient, often multifactorial and sometimes resulting from a mixture of pathophysiological abnormalities related to diabetic sequela and association with common GI ailments, such as irritable bowel syndrome. Similarly, some space is dedicated to the issue of constipation and fecal incontinence in the patient with diabetes, a particularly troublesome problem quite common in long-standing diabetics. The chapter also provides advice about indications and interpretation of various diagnostic test and reviews the main drugs now available or expected in the future for dealing with these various clinical problems.

Key Words: Diabetic diarrhea; dysphasia; gastroparesis; intestinal neuropathy; esophageal dys-motility; diabetic incontinence; gut autonomic dysfunction.

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