GI Problems in Patients With Diabetes

W. Steven Pray, PhD, DPh

Disclosures

Patients with diabetes experience a host of problems related to the condition, including problems with the eyes, feet, circulation, teeth, and the heart. This column focuses on the gastrointestinal (GI) problems experienced by patients with diabetes.

Of course, patients with diabetes are no less at risk for developing the same GI problems (e.g., gastroesophageal reflux, constipation, diarrhea) as those without diabetes. In other words, diabetes does not confer any gastroprotective effect to the patient. However, data demonstrate that some conditions are more common in diabetes, perhaps as a result of the inherent physiological changes (e.g., autonomic neuropathy, hyperglycemia) that occur with the condition, adverse effects of the medications prescribed for diabetes, or such factors as psychiatric comorbidities.[1,2]

Investigators in Australia surveyed adults ages 18 and over with a two-page questionnaire designed to elicit data regarding the frequency of GI symptoms experienced in the last three months.[3,4] Patients with diabetes exhibited a heightened risk for various GI disturbances (those with type 1 diabetes reported fewer symptoms than those with type 2).

One kind of problem was esophageal disturbances, in which estimates of prevalence for heartburn and dysphagia in normal patients were 10.8% and 1.7%, respectively. The corresponding figures for patients with diabetes were 13.5% and 5.4%.

The survey also included data on upper GI dysmotility syndromes. Individual dysmotility symptoms and their prevalence in patients without diabetes and those with diabetes were: early satiety (4.3% vs. 5.2% in patients with diabetes), postprandial fullness (5.2% vs. 8.6%), bloating (11.4% vs. 12.3%), nausea (3.5% vs. 5.2%), and vomiting (1.1% vs. 1.7%).

Constipation symptoms and their incidence was: less than three bowel movements per week (3.6% vs. 4.3%), lumpy or hard stools (5.5% vs. 7.4%), and a feeling of anal blockage (5% vs. 7.7%).

Diarrhea symptoms were measured, and their prevalence was: more than three bowel movements daily (5.3% vs. 8.4%), urgency to defecate (5.2% vs. 9.3%), and loose, watery stools (5.4% vs. 10%). Thus, according to this landmark study, numerous GI problems are more common in patients with diabetes.

Diabetes increases the risk of several esophageal abnormalities. These include reduced pressure of the lower esophageal sphincter--a defect that could lead to gastro esophageal reflux or worsen a preexisting propensity to reflux.

Investigators in Japan surveyed 241 patients with type 2 diabetes mellitus to determine the incidence of gastroesophageal reflux.[5] They discovered that 100 of the subjects experience GI symptoms not necessarily related to reflux, but 61 experienced symptoms of reflux. This finding explains the heightened incidence of reflux-associated symptoms, such as heartburn and dysphagia, as well as an increased incidence of odynophagia and chest pain, that was noted in the survey.[1,3] Autonomic neuropathy can produce esophageal motility disorders, increasing the duration of food retention in the esophagus.[1,6]

Gastroparesis is a condition in which the normal rate at which the stomach empties food into the duodenum is slowed. The effects of gastroparesis reflect the stomach

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