Gastrointestinal complications of diabetes mellitus

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

Figure 1

Molecular mechanisms involved in the vicious circle linking fatty liver to diabetes and diabetes to progressive liver injury. Left: The first part of the journey, leading from initial insulin resistance to fatty liver and eventually to the development of type 2 diabetes mellitus (T2DM) in those predisposed individuals in whom pancreatic lipotoxicity occurs; Right: The mechanism that (triggered by long-lasting/decompensated T2DM) may be conducive to progressive liver disease including primary liver cancer in predisposed individuals. HCC: Hepatocellular carcinoma; IL: Interleukin; NASH: Non-alcoholic steatohepatitis; PTEN: Phosphatase and tensin homolog. Reproduced from Loria et al[121].