Diabetic diarrhoea: A study on gastrointestinal motility, pH levels and autonomic function

Abstract

Background. Chronic diarrhoea is a common, but poorly investigated diabetes complication. Autonomic neuropathy is a leading pathophysiological theory founded on old, small studies. Studies of gastrointestinal motility and pH levels are lacking.Objectives. Using new diagnostic methods, we aimed to find out if diabetic diarrhoea was associated with alterations in gastrointestinal motility, pH levels and autonomic function.Methods. Fifty-seven patients (42 women, 46 with type 1 diabetes) were prospectively included. Symptoms were evaluated with the gastrointestinal symptom rating scale, defining ≥4 points as cases with diarrhoea. Patients scoring <4 were used as controls. We used the wireless motility capsule to measure gastrointestinal transit times, pH levels and contractility parameters. Autonomic function was assessed by measuring heart rate variability, baroreflex sensitivity and orthostatic hypotension.Results. Seventeen patients (30%) had diarrhoea. Compared with controls, cases had slower gastric emptying (21:46 vs. 4:14, h:min, p = 0.03) and faster colonic transit (18:37 vs. 54:25, p < 0.001). Cases had increased intraluminal pH in the antrum (2.4 vs. 1.2, p = 0.009), caecum (7.3 vs. 6.4, p = 0.008) and entire colon (7.1 vs. 6.7, p = 0.05). They also had a decreased pH difference across the pylorus (3.3 vs. 4.9, p = 0.004) and ileocaecal junction (0.6 vs 1.0, p = 0.009). The groups did not differ in autonomic function, but diastolic blood pressure drop correlated r s = −0.34 (p = 0.04) with colonic transit time. Conclusions.Patients with diabetic diarrhoea had altered gastrointestinal transit and intraluminal pH levels, but minimal changes in autonomic function. Our results suggest that tests of gastrointestinal function are clinically useful in diabetic diarrhoea.

Rural-urban differentials in the prevalence of diarrhoea among older adults in India: Evidence from Longitudinal Ageing Study in India, 2017–18

“…Generally, the incidence of diarrhoea remains a tremendous burden on population from low- and middle-income countries due to multiple determinants such as low socioeconomic status, lack of safe drinking water, inadequate sanitation, poor hygiene and crowding but the present study contradicts the existing literature and shows that the odds of older adults suffering from diarrhoea is higher among those who belonged to a richer section of the population [ 38 , 45 ]. Probable explanations for this finding could be: 1) A high prevalence of diabetes among older adults, in general and those belonging to high Socio Economic Status [ 46 – 48 ] and because diabetic diarrheoa is a major gastrointestinal discomfort [ 49 , 50 ], older adults belonging to the richer section may have a high prevalence of diarrhoea. 2) Since multimorbidity is higher among older adults [ 51 , 52 ], older adults may be consuming medicines that may cause diarrhoea.…”

Gut-Kidney Impairment Process of Adenine Combined with Folium sennae-Induced Diarrhea: Association with Interactions between Lactobacillus intestinalis, Bacteroides acidifaciens and Acetic Acid, Inflammation, and Kidney Function

“…Diarrhea, a common and frequent disease worldwide, accompanies the development of diabetes, tumors, ulcerative colitis and other diseases, and seriously affects the physical and mental health of patients and their quality of life [ 1 , 2 , 3 ]. The Kidney-Yang Deficiency Syndrome, as one of the common clinical syndromes of diarrhea in traditional Chinese medicine (TCM), is still challenging to study, due to the presence of complex pathogenic factors [ 4 ].…”