Treatment of gastrointestinal autonomic neuropathy

Abstract

The symptoms caused by gastrointestinal autonomic neuropathy in diabetes mellitus is important to highlight since it affects a large proportion of people with diabetes, regardless of whether this is type 1 or type 2. Gastroparesis and general signs of bowel dysfunction, such as constipation, diarrhoea and abdominal pain are most often encountered and involve both pharmacological and non-pharmacological treatment options. This mini-review summarises a presentation given at the 'Diagnosis and treatment of autonomic diabetic neuropathy in the gut' symposium at the 2015 annual meeting of the EASD. It is accompanied by another mini-review on a topic from this symposium (by Azpiroz and Malagelada,

A Severe Alkaline Gastritis in Type 1 Diabetes Gastroparesis: A Case Report

“…says the relationship between gastric emptying and postprandial glycaemia is complex and inter-dependent. Short-acting glucagon-like peptide-1 agonists, that slow gastric emptying, can be used to reduce postprandial glycaemic excursions and, in combination with basal insulin, result in substantial reductions in glycated haemoglobin in type 2 patients [4].…”

Gastrointestinal autonomic neuropathy in diabetes: the unattended borderline between diabetology and gastroenterology

“…The most common digestive complications of diabetes are impaired gastric motility, bowel dysfunctions and abdominal pain, and the therapeutic options for these complications are reviewed by Hans Törnblom in this issue [14].…”

Nutrition Management in Patients With Chronic Gastrointestinal Motility Disorders: A Systematic Literature Review

“…The disorder may be present in various parts of the GI tract and is predominantly caused by dysfunction or damage to the nerves supplying the smooth GI muscle, known as neuropathy, or to that of the smooth GI muscle itself, known as myopathy . The disorder may occur secondary to other conditions, including systemic sclerosis (SSc) and diabetes mellitus …”

“…3,4 The disorder may occur secondary to other conditions, including systemic sclerosis (SSc) and diabetes mellitus. 1,3,5 GI motility disorders differ from that of functional GI disorders in that they can be identified through routine motility testing such as x-ray motility or barium studies, endoscopic exams, and biopsies. 1,3 Functional GI disorders have no structural or biochemical signs of abnormality and are primarily diagnosed through reported symptoms.…”

“…8 In general, for chronic gastric and lower GI motility disorders, it is currently recommended that patients are encouraged to consume small, frequent, and highenergy, high-protein meals and to avoid high-fat or high-fiber/residue foods. [5][6][7] Evidence suggests that high-fat foods may delay gastric emptying, and high-fiber and highresidue foods may worsen symptoms and increase the risk of mechanical obstruction. 7,9 There is also some indication that excessive consumption of FODMAPs such as lactose and fructose may aggravate lower GI motility conditions.…”