Gastrointestinal Manifestations of Diabetes

Although most attention has traditionally been focused on the stomach, diabetes can affect the entire gastrointestinal tract. Gastrointestinal dysmotility in diabetes is caused by extrinsic (i.e. sympathetic and parasympathetic) neural dysfunction, hyperglycaemia, and hormonal disturbances. More recently, a role for intrinsic (i.e. enteric) neuronal dysfunction, resulting from loss of excitatory and inhibitory neurons and interstitial cells of Cajal, has also been implicated. Acute hyperglycaemia delays gastric emptying in healthy individuals and in people with type 1 diabetes. The mechanisms of constipation in diabetes have not been carefully studied and are poorly understood. Clinical observations suggest that, similar to idiopathic chronic constipation, both colonic dysmotility and anorectal dysfunctions (i.e. impaired anal sphincteric relaxation during defaecation) may contribute to constipation in diabetes. People with diabetes are obviously susceptible to the usual causes of abdominal pain seen in the general population.