Diabetes Mellitus and the Colon

Abstract

Opinion statement Diabetes mellitus (DM) can affect the structure and function of the colon promoting commonly encountered lower gastrointestinal symptoms such as constipation, diarrhea, abdominal distention, bloating, and abdominal pain. Specific colonic disorders for which adults with DM are at greater risk include chronic constipation, enteropathic diarrhea, colorectal cancer (CRC), inflammatory bowel disease, microscopic colitis, and Clostridium difficile colitis. Smooth muscle structure and function, density of the interstitial cells of Cajal, and the health and function of the autonomic and enteric nerves of the colon are all potential affected by DM. These effects can in turn lead to alterations in colon motility, visceral sensation, immune function, endothelial function, and the colonic microbiome. The evaluation and treatment for slow transit constipation as well as pelvic floor dysfunction should be considered when constipation symptoms are refractory to initial treatment measures. DM-related medications and small bowel conditions such as celiac disease and small intestinal bowel overgrowth should be considered and excluded before a diagnosis of enteropathic diarrhea is made. Given the higher risk of CRC, adults with DM should be appropriately screened and may require a longer bowel preparation to ensure an adequate evaluation.

Factors affecting bowel preparation adequacy and procedural time

“…Diabetes is thought to cause neuropathic injury, including demyelination and axonal degeneration, to those same nerves. Both can result in constipation, which leads to poor bowel preparation in these patients . The presence of risks factors for inadequate bowel preparation helps inform the decision of the regime and may indicate to the clinician that stricter bowel preparation is needed.…”

“…Both can result in constipation, which leads to poor bowel preparation in these patients. [23][24][25][26] The presence of risks factors for inadequate bowel preparation helps inform the decision of the regime and may indicate to the clinician that stricter bowel preparation is needed. These patients should also be targeted for further support and education, emphasizing the importance of compliance to avoid repeat colonoscopy.…”

Predictors of Clostridium difficile infection and predictive impact of probiotic use in a diverse hospital-wide cohort

“…Antibacterial and antifungal agents, bacterial and fungal probiotics, steroids and other immunosuppressants, statins, 18,19 proton pump inhibitors (PPIs), 20 and anti-diabetes medications 21 recorded within the 180-day window prior to the CDI diagnosis were included. Antibacterial agents were classified into low, moderate, and high CDI risk strata (Table 1).…”

Electroacupuncture promotes the gastrointestinal motility of diabetic mice by CNP/NPR‐B‐cGMP and PDE3A‐cGMP signaling

“…Delayed gastric emptying and slowed colonic transit are the common characteristics in diabetic patients with gastrointestinal motility disorder. 1,2 Although accompanied symptoms such as nausea, vomiting, early satiety, abdominal pain, and constipation greatly affect their life quality, various therapies are unsatisfactory for their few positive outcome and limitation in duration. Electroacupuncture (EA) is a safe and promising therapy, whose therapeutic effects on gastrointestinal dysmotility have been evaluated in many studies.…”