Diabetic Diarrhea: A Study of Thirteen Patients with Jejunal Biopsy

Malins, J. M.; Mayne, N

doi:10.2337/diab.18.12.858

Cited by 41 publications

(10 citation statements)

References 15 publications

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“…Histological and histochemical studies on the autonomic nerve fibres of the urinary bladder in diabetics have shown damage to nerve fibres and reduced or absent cholinesterase activity [20]. Diabetic autonomic neuropathy affecting the gastrointestinal tract and vascular reflexes has also been reported [21,22,23,24,25]. Earlier studies have also shown the frequency of abnormal bladder function in diabetic patients, based on clinical, radiological, endoscopic and manometric assessments [26,3,27,5,6,8].…”

Section: Discussionmentioning

confidence: 99%

Bladder dysfunction and neuropathy in diabetes

et al. 1976

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Established urodynamic and electrophysiological techniques have been applied to assess the frequency and extent of autonomic and peripheral neuropathy in 60 subjects with diabetes mellitus; 38 were diabetics with suggestive symptoms and the others were representative newly diagnosed (11) or treated (11) diabetics. Objective evidence neuropathic bladder dysfunction was detected in 43 of them (71.7%). The commonest abnormality was a hypotonic, insensitive large capacity bladder, which condition was usually asymptomatic. Less freuqently (15%) was this complicated by bladder decompensation and sphincter involvement, resulting in excessive residual urine and infection; some of these had bladder paralysis with chronic painless retention of urine (7%). Electrophysiological studies found a sensory defect in the lower limbs in all tested patients (100%), and in 41 patients (69%) as associated motor conduction abnormality, which was more frequent and marked in the lower than the upper limb. These functional abnormalities appeared to be related to the severity of diabetes, but less to its duration. Indeed of 11 newly diagnosed diabetics tested 7 had a peripheral neuropathy and 4 urodynamic abnormalities. The high incidence of bladder dysfunction and peripheral neuropathy in this series indicates the frequency of subclinical diabetic neuropathy and a factor needing more emphasis in diabetic uropathy.

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Section: Discussionmentioning

confidence: 99%

Bladder dysfunction and neuropathy in diabetes

et al. 1976

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“…The pathogenesis of this complaint remains obscure. Dysfunction of the exocrine pancreas (5-7) and the small bowel (6- 9) has not been shown to be of significance in this group of patients. It does appear (2-4, however, that the diarrhea is a manifestation of diabetic autonomic neuropathy, and it is postulated that this neuropathy may induce disturbances of gastrointestinal motility which cause the diarrhea.…”

mentioning

confidence: 86%

Abnormalities of the Migrating Motor Complex in Diabetics with Autonomic Neuropathy and Diarrhea

Dooley

Newihi

Zeidler

et al. 1988

Scandinavian Journal of Gastroenterology

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Diarrhea is a common symptom in long-standing diabetes. The pathogenesis of this diarrhea remains obscure, although it appears to be related to the development of autonomic neuropathy, which may cause several abnormalities including altered gut motility. We studied fasting gastrointestinal motility for a mean of 210 min in a group of 12 type-II diabetics with diarrhea. All patients had peripheral neuropathy and symptoms of autonomic neuropathy. Their motor activity was compared with that of a group of six normal volunteers. In addition, gastrointestinal transit time was assessed by the hydrogen breath test. The presence of bacterial overgrowth was assessed by the hydrogen breath test and culture of jejunal secretions. The diabetics showed grossly disordered motor activity. There was a complete absence of phase-III activity in two patients. Most phase III's commenced in the distal duodenum or jejunum. The phase-III component was often of short duration at each recording site. There was increased velocity of propagation between sites. Continuous phase-II activity was noted in some patients. Antral activity was absent or reduced during phase II. Gastrointestinal transit time was significantly prolonged in the diabetics. Bacterial overgrowth was demonstrated in three diabetic subjects. These motility abnormalities are nonspecific and are unlikely to play a major role in the pathogenesis of diabetic diarrhea.

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“…Measurement of small intestinal transit time has given conflicting results [39, 126, 142-144] but it is probably prolonged [145]. Jejunal biopsy shows no specific changes [38,39,110,146]. Tests of small bowel absorption are normal [110].…”

Section: Gastrointestinal Systemmentioning

confidence: 99%

Diabetic autonomic neuropathy

1979

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This review attempts to outline the present understanding of diabetic autonomic neuropathy. The clinical features have been increasinly recognised but knowledge of the localization and morphology of the lesions and their pathogenesis remains fragmentary. A metabolic causation as postulated in somatic nerves accords best with clinical observations. Most bodily systems, particularly the cardiovascular, gastrointestinal and urogenital, are involved with added disturbances of thermoregulatory function and pupillary reflexes. Possible effects on neuroendocrine and peptidergic secretion and respiratory control await definition. Current interest centres around the development of a new generation of tests of autonomic nerve function that are simple, non-invasive, reproducible and allow precision in diagnosis and accurate quantitation. Most are based on cardiovascular reflexes and abnormality in them is assumed to reflect autonomic damage elsewhere. Probably no single test suffices and a battery of tests reflecting both parasympathetic and sympathetic function is preferable. Little is known of the natural history. The prevalence may be greater than previously suspected and although symptoms are mild in the majority, a few develop florid features. The relation of control and duration of diabetes to the onset and progression of autonomic neuropathy is not clearly established. Once tests of autonomic function become abnormal they usually remain abnormal. Symptomatic autonomic neuropathy carries a greatly increased mortality rate possibly due to indirect mechanisms such as renal failure and direct mechanisms such as cardio-resiratory arrest. Improved treatment of some of the more disabling symptoms has been possible in recent years.

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Diabetic Diarrhea: A Study of Thirteen Patients with Jejunal Biopsy

Cited by 41 publications

References 15 publications

Bladder dysfunction and neuropathy in diabetes

Bladder dysfunction and neuropathy in diabetes

Abnormalities of the Migrating Motor Complex in Diabetics with Autonomic Neuropathy and Diarrhea

Diabetic autonomic neuropathy

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