Diabetic microangiopathy in the small bowel

Casas, Luis E. De Las; Finley, James M.

doi:10.1046/j.1365-2559.1999.00702.x

Cited by 16 publications

(10 citation statements)

References 18 publications

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“…Impaired function of the vascular system then leads to ischemia, stroke and consequently hypoxia and neuropathy [137][138][139] . Because of their dominant clinical incidence, the diabetes-induced alterations in the capillary endothelium of retina [140][141][142][143] and renal glomerulus [144,145] have been the focus of a vast number of studies, while except for an early case report on microangiopathy in a bowel biopsy [146] , the impact of diabetes on capillaries within the intestinal wall has been almost completely overlooked until now. The myenteric ganglia are not vascularized; accordingly, the capillaries adjacent to the MP have the role to supply them.…”

Section: Endothelial Dysfunction In the Gut Wallmentioning

confidence: 99%

Diabetes-related alterations in the enteric nervous system and its microenvironment

Bagyánszki

Bódi²

2012

WJD

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Gastric intestinal symptoms common among diabetic patients are often caused by intestinal motility abnormalities related to enteric neuropathy. It has recently been demonstrated that the nitrergic subpopulation of myenteric neurons are especially susceptible to the development of diabetic neuropathy. Additionally, different susceptibility of nitrergic neurons located in different intestinal segments to diabetic damage and their different levels of responsiveness to insulin treatment have been revealed. These findings indicate the importance of the neuronal microenvironment in the pathogenesis of diabetic nitrergic neuropathy. The main focus of this review therefore was to summarize recent advances related to the diabetes-related selective nitrergic neuropathy and associated motility disturbances. Special attention was given to the findings on capillary endothelium and enteric glial cells. Growing evidence indicates that capillary endothelium adjacent to the myenteric ganglia and enteric glial cells surrounding them are determinative in establishing the ganglionic microenvironment. Additionally, recent advances in the development of new strategies to improve glycemic control in type 1 and type 2 diabetes mellitus are also considered in this review. Finally, looking to the future, the recent and promising results of metagenomics for the characterization of the gut microbiome in health and disease such as diabetes are highlighted.

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Section: Endothelial Dysfunction In the Gut Wallmentioning

confidence: 99%

Diabetes-related alterations in the enteric nervous system and its microenvironment

Bagyánszki

Bódi²

2012

WJD

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“…As early as 1965, it was shown that the arterioles and capillaries of the submucosa showed the same pathologic changes and thickening in long-term diabetes as the blood vessels of other organs [21]. Other studies could not verify vascular complications in the bowel mucosa [22], but mural thickening and luminal narrowing in blood vessels in duodenal biopsies have been described recently again [23]. However, this has not been discussed or further examined in relation to the etiology of gastrointestinal dysmotility.…”

Section: Discussionmentioning

confidence: 99%

Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Sasor¹,

Ohlsson²

2014

Rev Diabet Stud

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■ Abstract OBJECTIVES:The pathophysiology behind gastrointestinal dysmotility in diabetes mellitus is unknown. Both esophageal dysmotility and gastroparesis have been shown to be associated with retinopathy, suggesting that microangiopathy is important in the common etiology. The aim of the present study was to examine whether patients with diabetes exhibit microangiopathy in the colon, and if present, to correlate microangiopathy with the clinical picture. METHODS: Consecutive patients subjected to colon surgery were identified in the southernmost districts of Skåne between January 2011 and May 2013. Medical records were scrutinized, and patients with a history of diabetes were noted. Gender, age, type of diabetes, treatment, complications, and other concomitant diseases were registered. Histopathologic reevaluation of surgical biopsies with morphometric analyses of submucosal vessels in the colon was performed. Morphometric examination and clinical data were compared with non-diabetic patients. RESULTS: Of 1135 identified patients during the time period studied, 95 patients with diabetes were recognized and included. Fifty-three non-diabetic, randomly chosen patients served as controls. The mean age was 71.8 ± 10.2 and 71.4 ± 9.5 years in diabetic and nondiabetic patients, respectively. Microangiopathy was found in 68.4% of diabetic patients and in 7.5% of non-diabetic patients (p < 0.001). The wall-to-lumen ratio was 0.31 (0.23-0.46) in patients with diabetes compared with 0.16 (0.12-0.21) in non-diabetic patients (p < 0.001). No clinical association with microangiopathy could be verified. CONCLU-SION: Microangiopathy in the colon is more common in diabetic than in non-diabetic patients. The clinical significance of microangopathy has yet to be clarified.

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“…When cardiovascular risk factors, cardiovascular diseases and associated treatments were specifically evaluated for their relationship to the development of colonic ischemia in a cohort of patients requiring admission due to an episode of ischemic colitis, diabetes mellitus (odds ratio (OR): 1.76, 95% CI: 1.001–3.077), dyslipidemia (OR: 2.12, 95% CI: 1.26–3.57), heart failure (OR: 3.17, 95% CI: 1.31–7.68), peripheral arterial disease (OR: 4.1, 95% CI: 1.32–12.72), and treatment with digoxin (OR: 0.27, 95% CI: 0.084–0.857) or acetylsalicylic acid (OR: 1.97, 95% CI: 1.16–3.36) were found to be independently associated with the development of ischemic colitis [15]. In diabetic patients, there is subepithelial collagenous thickening of colorectal mucosa along with basal membrane thickening and luminal narrowing in capillary vessels of the GI tract [16, 17]. These morphologic changes besides autonomic neuropathy-induced functional abnormalities in the mesenteric circulation may affect microvascular hemodynamics with deterioration of mesenteric microcirculation and development of colonic ischemia in the absence of major vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Colitis of the Left Colon in a Diabetic Patient

Karayiannakis

Bolanaki

Kouklakis

et al. 2011

Case Rep Gastroenterol

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Diabetic microangiopathy in the small bowel

Abstract: This is the first report of diabetic microangiopathy in a bowel biopsy. The pathogenesis, specificity and significance of these angiopathic changes, controversies about diabetic microangiopathy in the gastrointestinal tract, and the association with hypertension are discussed.

Cited by 16 publications

References 18 publications

Diabetes-related alterations in the enteric nervous system and its microenvironment

Diabetes-related alterations in the enteric nervous system and its microenvironment

Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Ischemic Colitis of the Left Colon in a Diabetic Patient

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