Diabetes‐induced mechanophysiological changes in the esophagus

Abstract

Esophageal disorders are common in diabetes mellitus (DM) patients. DM induces mechanostructural remodeling in the esophagus of humans and animal models. The remodeling is related to esophageal sensorimotor abnormalities and to symptoms frequently encountered by DM patients. For example, gastroesophageal reflux disease (GERD) is a common disorder associated with DM. This review addresses diabetic remodeling of esophageal properties and function in light of the Esophagiome, a scientifically based modeling effort to describe the physiological dynamics of the normal, intact esophagus built upon interdisciplinary approaches with applications for esophageal disease. Unraveling the structural, biomechanical, and sensory remodeling of the esophagus in DM must be based on a multidisciplinary approach that can bridge the knowledge from a variety of scientific disciplines. The first focus of this review is DM-induced morphodynamic and biomechanical remodeling in the esophagus. Second, we review the sensorimotor dysfunction in DM and how it relates to esophageal remodeling. Finally, we discuss the clinical consequences of DM-induced esophageal remodeling, especially in relation to GERD. The ultimate aim is to increase the understanding of DM-induced remodeling of esophageal structure and sensorimotor function in order to assist clinicians to better understand the esophageal disorders induced by DM and to develop better treatments for those patients.

Diabetes in relation to Barrett’s esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett’s and Esophageal Adenocarcinoma Consortium

“…Reasons for diabetes and regurgitation synergistically increasing the risk of EA/EGJA are not completely understood. However, putative mechanisms of diabetes‐induced mechanophysiological changes may explain our observation, including impaired lower esophageal sphincter relaxation and dysfunction of the esophageal body (eg, dysfunctional peristalsis), which may result in decreased motility, antral spasms, and gastroparesis, providing more opportunities for reflux. Diabetes and hyperglycemia may also be associated with gastroparesis through diabetic (vagal) neuropathy, which is thought to result from modification of proteins by advanced glycation end products, leading to development of atrophy and degeneration of nerve fibers …”

“…[10][11][12] Obesity has previously been associated with BE 13 and EA/EGJA. 14 Two hypotheses have been proposed for the association between obesity and these tumors: 1) mechanical effects on the integrity of the esophagogastric junction, including both direct somatic pathways, whereby central adiposity promotes the development of GERD, which may then promote BE development, 15 and indirect pathways, whereby diabetes induces mechanophysiological changes in the esophagus, which may then promote the development of tumors 16 ; or 2) systemic metabolic alterations because of obesity increasing the levels of various hormones, including insulin, which may promote the development of BE or the progression of BE to cancer. 17 Type 2 diabetes, which accounts for 95% of diabetes diagnoses, 18 is often characterized by hyperinsulinemia and has been associated with a higher risk of various cancers, including malignancies of the liver, pancreas, endometrium, colorectum, breast, and bladder.…”

“…Diabetes and hyperglycemia may also be associated with gastroparesis through diabetic (vagal) neuropathy, 76 which is thought to result from modification of proteins by advanced glycation end products, leading to development of atrophy and degeneration of nerve fibers. 16 The interaction between diabetes and regurgitation, but not heartburn symptoms, may be explained by diabetic neuropathy; patients who have GERD with diabetes report less frequent acid regurgitation symptoms than those who have GERD without diabetes, 77,78 whereas prior research indicates little to no decline in the frequency of heartburn symptoms in patients who have GERD with diabetes. 77,78 Symptomatic regurgitation compared with heartburn is associated with a higher proximal extent of the liquid reflux component, 79 which has been used as a proxy measure of increased contact time between the esophageal mucosa and gastric refluxate.…”

Diabetes-induced mechanophysiological changes in the small intestine and colon

“…It is well known that esophageal and gastric motility disorders are also very common in DM patients; however, these have been reviewed in detail recently (see references[11,12]). Furthermore, as we focus on the topic of DM-induced mechanophysiological changes in the small intestine and colon, the topic of esophageal and gastric disorders in the DM are not included in this review.…”

Queixa de deglutição em indivíduos com Diabetes Melito tipos 1 e 2

“…Tabela 10 -Frequência e percentil da presença de neuropatia nos grupos GDM1 e GDM2. ----------------------------------EAT<3 --------------------------------- , 1977;CHANNER et al, 1985;HOROWITZ et al, 1989;SCHVARCZ et al, 1996;HOROWITZ, 2006;ZHAO;GREGERSEN, 2016), podendo se manifestar em até 75% dos indivíduos (URANGA-OCIO et al, 2015).…”