Diabetic autonomic neuropathy of the gastrointestinal tract
- Thomas Frieling, MD
Thomas Frieling, MD
- Director Medizinische Klinik II
- HELIOS Klinikum Krefeld, Germany
- Section Editors
- Nicholas J Talley, MD, PhD
Nicholas J Talley, MD, PhD
- Section Editor — Motility Disorders
- Professor of Medicine, University of Newcastle, Australia
- Adjunct Professor of Medicine and Epidemiology and Consultant, Mayo Clinic, Rochester, MN
- Adjunct Professor, University of North Carolina
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
Diabetic autonomic neuropathy may involve the cardiovascular, genitourinary, and the neuroendocrine systems as well as the upper and lower gastrointestinal (GI) tract. Abnormalities of GI function in diabetics are thought to be related, at least in part, to autonomic neuropathy of the enteric nervous system.
This topic will review the GI manifestations of diabetic autonomic neuropathy. The other manifestations of diabetic autonomic neuropathy are discussed separately. (See "Diabetic autonomic neuropathy".)
Most studies assessing the prevalence of gastrointestinal GI symptoms in patients with diabetes mellitus have suggested that diabetics are more likely to experience GI symptoms as compared with controls [1-12]. Upper GI symptoms may be more common in patients with long-term type 1 diabetes mellitus . However, discordant data have also been reported. The difference among studies may in part be related to the inclusion of patients with varying disease severity and/or glycemic control. Furthermore, studies have not consistently used validated measures of GI symptoms .
The true prevalence of gastroparesis in patients with diabetes is unknown, and prevalence estimates have varied widely [15,16]. While in early studies in tertiary medical centers, up to 60 percent of patients with longstanding type 1 diabetes mellitus and GI symptoms had diabetic gastroparesis, these studies predated the use of intensive insulin treatment . In a population-based study, the 10-year incidence of symptomatic gastroparesis in patients with type 1 and 2 diabetes were 5 and 1 percent, respectively .
Estimates of the prevalence of diabetic diarrhea have varied widely between 8 and 22 percent [8,19]. It is likely, however, that the true incidence is substantially lower. In a population-based study, for example, no differences in the prevalence of diarrhea were detected among non-insulin-dependent diabetics, insulin-dependent diabetics, and healthy controls . In another study that included 200 diabetic patients attending an outpatient clinic, only two complained of nocturnal diarrhea, both of whom had autonomic neuropathy .
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- GASTROESOPHAGEAL REFLUX DISEASE
- Clinical manifestations
- - Effect of serum glucose on gastric emptying
- - Effect of gastric emptying on serum glucose
- Clinical manifestations
- DIABETIC DIARRHEA
- Clinical manifestations
- Diagnostic evaluation
- Differential diagnosis
- - Supportive care
- - Treatment of underlying cause
- - Symptomatic treatment
- - Other
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS