Gastrointestinal Complications of Diabetes

Cecilio R. Azar, MD
Clinical Associate, GI Division AUBMC
Head of GI Division, MEIH

Diabetes mellitus can affect anywhere is the gastrointestinal (GI) tract from the esophagus to the anorectal area.

The most common GI complications of diabetes include gastroparesis (lazy stomach or delayed gastric emptying), intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. These complications and their symptoms are often caused by abnormal gastrointestinal motility, which is a consequence of diabetic autonomic neuropathy. Such complications are associated with poor blood glucose control and not necessarily the duration of diabetes. Esophageal manifestations include abnormal movements, spontaneous contractions, and impaired lower esophageal sphincter tone, result in heartburn and difficulty swallowing (dysphagia). Gastroparesis or delayed gastric emptying is a common consequence of diabetes. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. Delayed gastric emptying contributes to poor blood glucose control and may be the first indication that a patient is developing gastroparesis. Intestinal enteropathy in patients with diabetes may present as constipation, diarrhea, or fecal incontinence. Constipation is one of the most common complications of diabetes. Almost half of patients with diabetes reported constipation or increased use of laxatives. Patients may also develop diarrhea, which leads to malnutrition, and weight loss. Sometimes anti-diabetic medications (such as metformin) can cause diarrhea. Nonalcoholic fatty liver disease is the term used to describe a liver condition in patients who have a pathology resembling alcohol-induced liver injury but lack a history of significant alcohol consumption. It is often associated with diabetes and obesity. In some cases, nonalcoholic fatty liver disease may progress with varying degrees of inflammation, in rare cases to cirrhosis.

So in summary, most gastrointestinal complications can be avoided and controlled by strict normalization of blood glucose levels.

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