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Hépato-Gastro & Oncologie Digestive

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Digestive impairment in diabetes mellitus Volume 19, issue 5, Mai 2012

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Authors
Hôpital Charles Nicolle, service d’hépato-gastroentérologie et de nutrition/ADEN Inserm UMR-1073, Hôpital Charles Nicolle, service de physiologie digestive et urinaire/ADEN Inserm UMR-1703, 76031 Rouen Cedex, Hôpital de Bois Guillaume, service d’endocrinologie, diabète et maladies métaboliques, 76031 Rouen Cedex

The prevalence of diabetes mellitus (types 1 and 2) is about 4.4% in France. Gastroenteropathy concerns more than 75% of both types of diabetic patients, impairs quality of life and increases mortality. Major symptoms are heartburn, dysphagia, early satiety, abdominal post-prandial discomfort, diarrhea, constipation and fecal incontinence. Possible pathophysiological explanations for the digestive tract involvement include autonomic neuropathy, enteric nervous system impairment with a loss of both neurons and interstitial cells of Cajal, increased intestinal permeability and changes in gut microbiota while the role of an incomplete glycaemic control cannot be omitted in the worsening of both gut dysfunction and symptoms. All symptoms are entangled, making the diagnosis difficult and no therapeutic guidelines have been published. The aim of this review is to describe the clinical patterns and the pathophysiology of the diabetic gastro-enteropathy and to give some therapeutic recommendations to improve patients.