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Diabetic gastroenteropathy: a pan-alimentary complication.
Ditte S Kornum1,2,3, Klaus Krogh1,2,3, Jutta Keller4
1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Diabetologia
|February 11, 2025
Summary
Diabetic gastroenteropathy, caused by autonomic neuropathy, affects the entire digestive system, leading to burdensome symptoms. Management focuses on glycemic control, diet, medications, and sometimes invasive procedures for symptom relief.
Area of Science:
- Gastroenterology
- Endocrinology
- Diabetic Complications
Background:
- Diabetic gastroenteropathy stems from autonomic neuropathy, impacting the entire GI tract, pancreas, and gallbladder.
- Morphological changes in the enteric nervous system, smooth muscle, and vasculature cause widespread motor, sensory, and secretory disturbances.
- GI symptoms are often non-specific, severe, and linked to poor glycemic control, malnutrition, and reduced quality of life.
Purpose of the Study:
- To review the prevalence, pathophysiology, clinical presentation, assessment, and treatment of diabetic gastrointestinal dysfunction.
- To highlight the impact on each GI segment and connected exocrine organs.
- To discuss current and potential therapeutic strategies.
Main Methods:
- Comprehensive literature review of diabetic gastrointestinal dysfunction.
- Analysis of pathophysiology, clinical manifestations, and diagnostic tools.
- Evaluation of current and emerging treatment modalities.
Main Results:
- Autonomic neuropathy causes significant GI tract remodelling and functional disturbances.
- Validated questionnaires (Gastroparesis Cardinal Symptom Index, Gastrointestinal Symptom Rating Scale) aid symptom assessment.
- Objective measures like transit time assessments are crucial but have limitations.
Conclusions:
- Effective management requires improved glycemic control, dietary adjustments, and targeted pharmacotherapy.
- Invasive interventions like gastric neurostimulation are options for refractory gastroparesis.
- A holistic approach addressing all GI segments and exocrine functions is essential for managing diabetic gastrointestinal dysfunction.
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