Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

Abstract

Objectives: To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents.Sources: Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases , as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. Summary of the findings:Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. Conclusions:There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus. J Pediatr (Rio J). 2012;88(1):17-24:Diabetes mellitus, digestive signs and symptoms, gastrointestinal motility, etiology, child, adolescent. ResumoObjetivos: Apresentar a frequência, os principais fatores causadores dos sintomas gastrointestinais em pacientes portadores do diabetes melito e controvérsias quanto à sua ocorrência em crianças e adolescentes. Fontes dos dados:Revisão não sistemática nas bases de dados MEDLINE/PubMed e SciELO (1983-2011), além de capítulos de livros relevantes. Foram selecionados os artigos mais atuais e representativos do tema. Síntese dos dados:A prevalência do diabetes melito vem aumentando ao longo dos anos em vários países do mundo. No sistema digestório, é conhecida a ocorrência de complicações do diabetes melito, entre elas os sintomas gastrointestinais (náuseas, vômitos, dor abdominal, azia, disfagia, constipação, diarreia e incontinência fecal). A patogênese das alterações das funções gastrointestinais no diabetes melito está ainda sob investigação, e o papel do sistema nervoso entérico e seus neurotransmissores tem ganhado significância. Em decorrência do comprometimento do sistema digestório, com danos ao sistema nervoso entérico, portadores do diabetes melito podem apresentar quadros específicos de distúrbios de motilidade, alguns de grande re...

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

“…However, these results do not enable us to rule out the participation of autonomic neuropathy in the pathogenesis of dyspeptic symptoms, once the appropriate tests to investigate this change were not used in the present study. It is important to mention, however, that previous studies did not evidence good correlations between digestive symptoms and diabetic autonomic neuropathy, suggesting a multifactorial physiopathology for dyspepsia in these patients (5,30). The results of the present study seem to fit the current view that digestive symptoms in DM1 are result of a complex relationship between psychological changes, glycemic control, visceral hypersensitivity, and autonomic neuropathy (15,33).…”

“…It was also demonstrated that this clinical picture has a negative impact in the quality of life of these patients (4). However, the mechanisms responsible for digestive manifestations in diabetes have not been elucidated, yet (5).…”

“…Studies that investigated the relationship between digestive symptoms and Helicobacter pylori infection (8), glycemic control (1,9), and abnormal autonomic function (5) in diabetes also showed contradictory results. Besides, no direct relationship was demonstrated between diabetic gastroparesis and specific digestive symptoms (10,11).…”

Prevalence of faecal incontinence and its related factors among patients in a Malaysian academic setting

“…In this study, we found FI was associated with diabetes mellitus (13.9% vs. 7.6%, p = 0.026). Other studies have also shown FI to be a concern for diabetics due to damage to the nervous system caused by long-standing diabetes [33-35]. A majority of patients in this study had mild incontinence (76%) and only 6.0% had severe incontinence as measured by the WCS.…”

Combination vitamin C and vitamin E prevents enteric diabetic neuropathy in the small intestine in rats

“…Thus, an increase in neurotransmitter levels possibly occurred, which can promote gastrointestinal changes because NO is a major inhibitory neurotransmitter in the intestine (Furness 2012). An important consideration is that diabetic patients exhibit alterations in intestinal motility, which may result in an increase in intestinal transit time or diarrhea (Rodrigues and Motta 2012). Intestinal transit may be imbalanced in diabetes.…”