This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient.

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Fecal incontinence (FI) is underreported, yet it is quite commonly experienced by the elderly patient. FI confers a significant direct and indirect burden on patients, their caregivers, and the health-care system. Due to the presence of multiple comorbid medical conditions in patients over 65 years of age and the number of medications taken by elderly patients, FI management poses several challenges to the treating physician. We emphasize the importance of a comprehensive history and physical exam with specific attention to diet, physical activity, cognitive function, medications, and comorbidities specific to patients in this age group. Symptomatic conservative therapy should be the first step in management. Evaluation of the underlying pathology causing FI and more invasive treatments should be considered in selected patients who are cognitively intact and can tolerate these procedures.