Gastrointestinal involvement in insulin-requiring diabetes mellitus

Gastrointestinal (GI) dysfunction in diabetes mellitus has never been evaluated systematically in all parts of the digestive system in a group of diabetics. Therefore, we have evaluated the frequency, extent, and clinical significance of GI complications in 75 consecutive, male, insulin-requiring diabetics (46 with neuropathy). Nineteen percent of the 75 patients and 30% of those with neuropathy had one or more GI symptoms. Esophageal, gastric, gallbladder, and small intestinal functions were studied in 30 patients using radionuclide esophageal and gastric emptying, postprandial gallbladder emptying, and intestinal transit of lactulose. We divided them into three groups: (1) 10 without neuropathy, (2) 10 with peripheral neuropathy, and (3) 10 with autonomic and peripheral neuropathy. Twenty-five patients (83%) had abnormalities of at least one GI organ, and 57% had abnormalities of two. Nineteen of the 25 patients (76%) with GI involvement and 8 of 9 (89%) symptomatic diabetics had delayed esophageal emptying. Symptomatic diabetics had more diabetic retinopathy, neuropathy, and autonomic dysfunction than asymptomatic diabetics and also had more widespread and more severe gastrointestinal involvement than asymptomatic diabetics. Therefore, our results indicate that in diabetics, (1) gastrointestinal motor abnormalities are common even though they are usually asymptomatic and (2) gastrointestinal dysfunction, especially in symptomatic diabetics, is often widespread and usually includes the esophagus.