Gastrointestinal complications of diabetes mellitus

Abstract

Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease, and other co-morbidities. Gastrointestinal (GI) involvement can present with esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors. Diabetic gastroparesis manifests as early satiety, bloating, vomiting, abdominal pain and erratic glycemic control. Gastric emptying scintigraphy is considered the gold standard test for diagnosis. Management includes dietary modifications, maintaining euglycemia, prokinetics, endoscopic and surgical treatments. Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures. NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment is mainly lifestyle measures, with diabetes and dyslipidemia management when coexistent. Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment. Though GI complications of diabetes are relatively common, awareness about its manifestations and treatment options are low among physicians. Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient. This review is an update on the GI complications of diabetes, their pathophysiology, diagnostic evaluation and management.

Keywords: Gastrointestinal complications; Diabetes mellitus; Esophageal complications; Nonalcoholic fatty liver disease; Diabetic gastroparesis; Diabetic enteropathy; Glycogenic hepatopathy

Core tip: Although relatively common, gastrointestinal (GI) complications of diabetes mellitus are under-recognized by most physicians. Early identification and prompt management of GI complications are of paramount importance as they are associated with significant morbidity. Common GI complications are esophageal dysmotility, gastro-esophageal reflux disease, gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Damage to the myenteric neurons due to longstanding diabetes causes esophageal, gastric and enteric disease. NAFLD is a hepatic manifestation of metabolic syndrome and is commonly seen in type 2 diabetes while glycogenic hepatopathy is due to poor glycemic control in type 1 diabetes. Clinical manifestations, pathogenesis, diagnostic evaluation and management of GI complications of diabetes are discussed in this article.