Diabetes and the Small Intestine

Abstract

Diabetes mellitus (DM) and its associated complications are becoming increasingly prevalent. Gastrointestinal symptoms associated with diabetes is known as diabetic enteropathy (DE) and may manifest as either diarrhea, fecal incontinence, constipation, dyspepsia, nausea, and vomiting or a combination of symptoms. The long-held belief that vagal autonomic neuropathy is the primary cause of DE has recently been challenged by newer theories of disease development. Specifically, hyperglycemia and the resulting oxidative stress on neural networks, including the nitrergic neurons and interstitial cells of Cajal (ICC), are now believed to play a central role in the development of DE. DE occurs in the majority of patients with diabetes; however, tools for early diagnosis and targeted therapy to counter the detrimental and potentially irreversible effects on the small bowel are lacking. Delay in diagnosis is further compounded by the fact that DE symptoms overlap with those of gastroparesis or can be confused with side effects from diabetes medications. Still, early recognition of the presence of DE is essential to mitigating symptoms and preventing further progression of complications including dysmotility and malabsorption. Current diagnostic modalities include manometry, wireless motility capsule (SmartPill™), and scintigraphy; however, these are not regularly utilized in clinical practice due to limited availability. Several medications are available for symptom relief in DE patients including rifaximin for small intestinal bacterial overgrowth (SIBO) and somatostatin analogues for diarrhea. While rodent models on stem cell therapy and alteration of the microbiome are promising, there is still a great need for further research on the pathologic underpinnings and development of novel treatment modalities for DE.

Structural changes of duodenal mucosa enterocytes of rats in burn skin injury under experimental streptozotocin-induced diabetes mellitus

“…Diabetes mellitus and its related complications are becoming more common. The complex of gastrointestinal symptoms associated with diabetes is now known as diabetic enteropathy and can manifest as diarrhea, fecal incontinence, constipation, dyspepsia, nausea and vomiting [6]. The ancient theory that autonomic neuropathy is a major contributor to diabetic enteropathy has recently been supplemented by new theories of disease development.…”

“…Particularly unfavorable is the course of burn disease in the context of its association with diabetes mellitus [6,16]. However, structural changes enterocytes of the mucous membrane duodenum the conditions of association burn disease with diabetes have so far remained unheeded by researchers.…”

“…However, structural changes enterocytes of the mucous membrane duodenum the conditions of association burn disease with diabetes have so far remained unheeded by researchers. On this basis, the important role of duodenal dysfunction in the pathogenesis of burn disease [4,6] determines the need to study the morphogenesis of destructive and regenerative processes in its mucous membrane at different times after burn injury under the conditions of the course of diabetes mellitus.…”

Antidiarrheal effect of sodium hydrosulfide in diabetic rats: In vitro and in vivo studies

“…It has been shown that the total number of duodenal myenteric neurons (VIP expressing inhibitory neurons, and nNOS neurons) decrease in diabetic type 2 mice . Moreover, recent reports have been indicated that hyperglycemia, and diabetic‐induced oxidative stress damage interstitial cells of cajal, and nitrergic neurons in enteric nervous system . Hydrogen sulfide has been also found in enteric nervous system .…”

“…21 Moreover, recent reports have been indicated that hyperglycemia, and diabetic-induced oxidative stress damage interstitial cells of cajal, and nitrergic neurons in enteric nervous system. 22 Hydrogen sulfide has been also found in enteric nervous system. 23 Our results also suggest the potential capacity of H 2 S synthesis reduced in diabetic-induced diarrhea.…”