Rarely do people talk about their bowels-it’s a taboo subject, embarrassing and hidden. We wear layers of clothes, we use euphemisms, we don’t talk about discomfort in our bowels. Guess what, people? Everyone has them. And most everyone with diabetes will have some sort of trouble with their bowels in their lifetime. It may be trouble digesting vegetables or meat, it may be IBS, it may be Crohn’s or another disease. Read on.
As many as 75% of patients visiting diabetes clinics will report significant GI symptoms. The entire GI tract can be affected by diabetes from the oral cavity and esophagus to the large bowel and anorectal region. Thus, the symptom complex that may be experienced can vary widely. Common complaints may include dysphagia, early satiety, reflux, constipation, abdominal pain, nausea, vomiting, and diarrhea. Many patients go undiagnosed and under-treated because the GI tract has not been traditionally associated with diabetes and its complications.
Both acute and chronic hyperglycemia can lead to specific GI complications. Diabetes is a systemic disease that may affect many organ systems, and the GI tract is no exception. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise, and this is best determined by asking a few simple questions. (See “Patient Information“.)
Many GI complications of diabetes seem to be related to dysfunction of the neurons supplying the enteric nervous system. Just as the nerves in the feet may be affected in peripheral neuropathy, involvement of the intestinal nerves may lead to enteric neuropathy. This is a type of autonomic or “involuntary” neuropathy and may lead to abnormalities in intestinal motility, sensation, secretion, and absorption. Different nerve fibers can either stimulate or inhibit intestinal motility and function, and damage to these nerves can lead to a slowing or acceleration of intestinal function, giving rise to a variable symptom complex. This article will highlight the most common GI disorders seen in people with diabetes.