Diabetic gastroenteropathy: An underdiagnosed complication

Abstract

This article is an extensive review that provides an update on the pathophysiology, symptoms, diagnosis, and treatment of diabetic gastroenteropathy. There is no reported prevalence, but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%, and type 2 patients, 1%. Also, in the group of type 1 diabetes, it has been observed that women are more likely to present this condition (5.8% vs 3.5%). Many factors are associate with its development (e.g., hyperglycemia, vagal dysfunction, loss of expression of neural nitric oxide synthase in the myenteric plexus, alterations in the Cajal interstitial cell network, and oxidative stress). Gastrointestinal discomfort could be perceived 70% higher in diabetic patients, describing that 25% of diabetic patients experience gastrointestinal symptoms. Diabetic enteropathy could affect any portion of the gastrointestinal tract, but esophageal alterations were described in more than 60% of diabetic patients, also 60% of them present constipation, and 20%, diarrhea. Gastric emptying scintigraphy is useful to evaluate gastroparesis, therefore, gastric retention of more than 60% at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis; however, other studies such as breath tests, with a sensitivity of 89% and a specificity of 80%, or the endoscopic capsule contribute to the diagnosis. There is no cure; however, management must be multidisciplinary, focused on slowing the progression of diabetic gastroenteropathy, reducing symptoms, and restoring function; that includes nutritional recommendation, maintain glucose levels kept below 180 mg/dL, use of prokinetics, anti-emetics; nowadays, it has been special interest in surgical treatment, such as pyloroplasty, also gastric electrical stimulation appears to be another alternative.

Keywords: Gastroenteropathy; Gastroparesis; Diabetes mellitus; Complication; Gastrointestinal disease; Treatment

Core Tip: Diabetic gastroenteropathy is a common complication, poorly diagnosed in patients with long-term disease. These can present esophageal, gastric, intestinal, and even anorectal symptoms. Gastrointestinal Symptom Severity Index, Gastroparesis Cardinal Symptom Index, and Assessment of Constipation Quality of Life scores, as well as symptomatic assessment scales, contribute to the diagnosis. Apart from gastric emptying scintigraphy, currently, the use of endoscopic capsules has allowed the evaluation of abnormal transit. Jejunal fluid aspiration and culture allow assessment of bacterial overgrowth. Medical treatment, as well as adequate glycemic control, improve the symptoms, and delay the progression of the disease; in selected patients, pyloroplasty and gastric electrical stimulation are useful.