Title:Diabetic Gastroenteropathy: Soothe the Symptoms or Unravel a Cure?
Volume: 18
Issue: 5
Author(s): Sondre Meling*, Davide Bertoli, Dag A. Sangnes, Christina Brock, Asbjørn Drewes, Niels Ejskjaer, Georg Dimcevski and Eirik Søfteland
Affiliation:
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
Keywords:
Diabetes mellitus, autonomic neuropathy, diabetic gastroenteropathy, diagnostics, novel treatment, pharmacological, endo-surgical, neuromodulation.
Abstract: Autonomic neuropathy in patients with diabetes mellitus, and especially complications
related to gastrointestinal neuropathy, are often overlooked in the clinic. Diabetic gastroenteropathy
affects every segment of the gastrointestinal tract and generates symptoms that may include
nausea, early satiety, vomiting, abdominal pain, constipation, and diarrhea. Severe cases can be
complicated by weight loss, dehydration, and electrolyte disturbances. The pathophysiology is complex,
the diagnostics and treatment options are multidisciplinary, and there is generally a lack of
evidence for the treatment options. The aims for this review are first to summarize the pathophysiology
and describe possible and expected symptoms and complications.Further, we will try to supply
the clinician with a straightforward tool for diagnostics, and then, we shall summarize established
treatment options, including diet recommendations, pharmacological and non-pharmacological options.
Finally, we will explore the multiple possibilities of novel treatment, looking at medications
related to the pathophysiology of neuropathy, other manifestations of autonomic neuropathies, and
symptomatic treatment for other gastrointestinal disorders, also including new knowledge of endosurgical
and neuromodulatory treatment. The overall goal is to increase awareness and knowledge
on this frequent diabetic complication and to provide better tools for diagnosis and treatment. Ultimately,
we hope to encourage further research in this field, as there are clear shortcomings in terms
of biomarkers, pathophysiology, as well as treatment possibilities. In conclusion, diagnosis and management
of diabetic gastroenteropathy are challenging and often require multidisciplinary teams
and multimodal therapies. Treatment options are sparse, but new pharmacological, endoscopic, and
neuromodulatory techniques have shown promising results in initial studies.
