Review
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World J Diabetes. Jun 15, 2013; 4(3): 51-63
Published online Jun 15, 2013. doi: 10.4239/wjd.v4.i3.51
Gastrointestinal complications of diabetes mellitus
Babu Krishnan, Shithu Babu, Jessica Walker, Adrian B Walker, Joseph M Pappachan
Babu Krishnan, Department of Gastroenterology, University College Hospital, London NW1 2BU, United Kingdom
Shithu Babu, Department of Medicine, Watford General Hospital, London WD18 0HB, United Kingdom
Jessica Walker, University of Newcastle, Newcastle upon Tyne NE1 7RU, United Kingdom
Adrian B Walker, Joseph M Pappachan, Department of Endocrinology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Author contributions: Krishnan B and Pappachan JM conceived the idea; Krishnan B, Babu S and Pappachan JM wrote the initial draft of the paper; all authors contributed to literature search and final preparation of the manuscript.
Correspondence to: Dr. Joseph M Pappachan, MD, MRCP, Department of Endocrinology, University Hospital of North Staffordshire NHS Trust, Princes Rd, Stoke-on-Trent ST4 6QG, United Kingdom. drpappachan@yahoo.co.in
Telephone: +44-1782-715444 Fax: +44-1782-674650
Received: March 5, 2013
Revised: April 14, 2013
Accepted: April 18, 2013
Published online: June 15, 2013
Processing time: 107 Days and 10.7 Hours
Abstract

Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease, and other co-morbidities. Gastrointestinal (GI) involvement can present with esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors. Diabetic gastroparesis manifests as early satiety, bloating, vomiting, abdominal pain and erratic glycemic control. Gastric emptying scintigraphy is considered the gold standard test for diagnosis. Management includes dietary modifications, maintaining euglycemia, prokinetics, endoscopic and surgical treatments. Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures. NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment is mainly lifestyle measures, with diabetes and dyslipidemia management when coexistent. Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment. Though GI complications of diabetes are relatively common, awareness about its manifestations and treatment options are low among physicians. Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient. This review is an update on the GI complications of diabetes, their pathophysiology, diagnostic evaluation and management.

Keywords: Gastrointestinal complications; Diabetes mellitus; Esophageal complications; Nonalcoholic fatty liver disease; Diabetic gastroparesis; Diabetic enteropathy; Glycogenic hepatopathy

Core tip: Although relatively common, gastrointestinal (GI) complications of diabetes mellitus are under-recognized by most physicians. Early identification and prompt management of GI complications are of paramount importance as they are associated with significant morbidity. Common GI complications are esophageal dysmotility, gastro-esophageal reflux disease, gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Damage to the myenteric neurons due to longstanding diabetes causes esophageal, gastric and enteric disease. NAFLD is a hepatic manifestation of metabolic syndrome and is commonly seen in type 2 diabetes while glycogenic hepatopathy is due to poor glycemic control in type 1 diabetes. Clinical manifestations, pathogenesis, diagnostic evaluation and management of GI complications of diabetes are discussed in this article.