[Gastrointestinal complications in diabetes mellitus]

Impaired function of the gastrointestinal tract related to diabetes mellitus (DM) results from diabetic autonomous neuropathy, impaired sensory innervation and a direct effect of chronic hyperglycaemia. Another possible connection between DM and the gastrointestinal tract can be infrequent autoimmune diseases associated with type I DM (celiac disease, autoimmune gastropathy, autoimmune chronic pancreatitis). Functional or organic changes resulting from diabetes can be seen in every organ of the gastrointestinal tract. Some of the diabetic gastrointestinal tract difficulties affect almost 60% of patients with long lasting diabetes. On one side, impaired function of individual organs in diabetics can significantly influence level of diabetes compensation and vice versa. On the other side, unsatisfactory diabetes compensation can result in manifestation of digestive problems. The most frequent and the most serious clinical complication is diabetic gastroparesis (DG). The highest incidence of impaired evacuation and motility of the stomach (and the small intestine) is described in diabetics with long lasting unsatisfactory diabetes compensation, microangiopathic complications, and diabetic neuropathy (55-75% in type I diabetes and 15-20% in type II diabetes). Symptoms accompanying impaired motility and emptying of the stomach (feeling of early fullness, eructation, nausea, vomiting and abdominal pains) can be only temporary or can be missing in some patients. Hyperglycaemia accompanied by slowing down evacuation of the stomach is different in patients with an empty stomach--glycaemia over 7.8 mmol/l, and postprandially--antral motility decreases after blood glucose levels get over 9.7 mmol/l. Treatment options for symptomatic diabetic gastroparesis are limited. Achieving normoglycaemia usually improves diabetic gastroparesis but in up to 80% of cases simultaneous administration of prokinetics is necessary.