Diabetic gastroenteropathy: An underdiagnosed complication

Figure 1 Timeline. Since the discovery of insulin until nowadays[4,5].

Figure 2 Control of gut motor function. The motor function of the gut is controlled by parasympathetic and sympathetic nervous systems, enteric neurons and interstitial cell of Cajal, smooth muscle cells. ICC: Interstitial cell of Cajal; ICC_SM: ICC-submucosal; ICC_DMP: ICC-deep muscular plexus; ICC_MY: ICC-myenteric; ICC_IM: ICC-intramuscular.

Figure 3 Pathophysiology of diabetic gastroparesis. Dysfunction in the Sympathetic nervous system (Celiac Ganglion), parasympathetic nervous system (Vagus Nerve) and enteric nervous system (Myenteric Interstitial cells of Cajal). Results in the dysfunction of emptying mechanism of the antral pump: phase of propulsion, emptying, and retropulsion (blue arrows), decrease of relaxes to accommodate meal (black arrows), loss of Nitric Oxide synthase in the enteric nerves (fundus, pylori), loss of ICC, Type 2 Macrophage altered function with loss of cytoprotective to ICC, smooth muscle atrophy, and increased smooth muscle fibrosis. NO: Nitric oxide; VIP: Vasoactive inhibitory peptide; ICC: Interstitial of cajal cell.

Figure 4  Diagnostic algorithm for diabetic gastroenteropathy.

Figure 5  Management of diabetic gastroenteropathy.