Abstract
Patients with diabetes often have gastrointestinal symptoms, but the extent and severity of this problem and the specificity of the symptoms are not nearly as well defined as frequently assumed. Any part of the gastrointestinal tract can be affected, and the presenting symptoms depend on the composite of dysfunctional elements. Gastroesophageal reflux, Candida esophagitis, gastroparesis, diarrhea and constipation are among the many common gastrointestinal complications of diabetes. No specific risk factor for the development of these complications has been identified and their etiology is most likely to be multifactorial, involving both reversible and irreversible processes. Treatment should be directed at tighter glycemic and symptom control, which can bring about clinical improvement for many patients. For other patients, however, effective clinical management is problematic because no therapies are available to prevent or correct the underlying disease mechanisms. Studies now suggest that reduced levels of key trophic factors cause transdifferentiation of pacemaker interstitial cells of Cajal into a smooth-muscle-like phenotype. If this really is the case, therapies directed at restoring the normal milieu of trophic signals could correct the dysfunction of the interstitial cells of Cajal and resolve many gastrointestinal complications. Advances in stem cell technology also hold promise to provide a cure for diabetes and to correct abnormalities in gastrointestinal pathology.
Key Points
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Gastrointestinal symptoms are common in patients with diabetes, but are also prevalent in the general population
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Any part of the gastrointestinal tract can be affected and presenting symptoms depend on the composite of dysfunctional elements
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No specific risk factor for the development of gastrointestinal complications in patients with diabetes has been identified and the etiology of these complications is probably multifactorial, involving both reversible and irreversible processes
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Treatment should be directed at tighter glycemic and symptom control, which can bring about clinical improvement for many patients; for other patients, effective clinical management is problematic because no therapies are available to prevent or correct the underlying disease mechanisms
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The development of new approaches, including restoration of normal levels of trophic factors and stem cell therapy, are key to the effective and specific treatment of intractable gastrointestinal complications of diabetes.
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Special thanks to Dr Jay Pasricha for his help and guidance in preparing this manuscript.
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Sellin, J., Chang, E. Therapy Insight: gastrointestinal complications of diabetes—pathophysiology and management. Nat Rev Gastroenterol Hepatol 5, 162–171 (2008). https://doi.org/10.1038/ncpgasthep1054
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DOI: https://doi.org/10.1038/ncpgasthep1054
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