Diabetic autonomic neuropathy of the gastrointestinal tract – etiopathogenesis , diagnosis, treatment and complications

Abstract

Introduction. Late complications of diabetes mellitus are a serious challenge for physicians treating diabetic patients. Micro-and macro-angiopathic changes are of the most severe sequels. However, it should be remembered that the effects of long-term diabetes are also associated with changes in the peripheral nervous system. One of the complications most troublesome for patients is diabetic autonomic neuropathy of the gastrointestinal (GI) tract. Objective. The review article presents the pathogenesis of diabetic neuropathy of the autonomous gastrointestinal tract, and advances in the diagnosis and treatment of this disease. The study used materials in the database which demonstrate current standards of conduct, based on the principles of EBM. Brief description of the state of knowledge. Diabetic neuropathy is one of the most common complications of diabetes mellitus. According to epidemiologists, it affects 10% to even 100% of patients with long-standing disease. Damage to the nervous fibres mainly results from hyperglycaemia, which leads to the typical symptoms of dysfunction of GI tract segments. The main additional examinations include abdominal ultrasound (US) and abdominal X-ray. In cases with oesophageal disorders accompanied by dysphagia, gastroscopy is found useful for excluding possible neoplastic lesions. The gold standard for evaluation of gastric emptying is radioisotopic scintigraphy, however it is available only in some specialistic departments. Other recommended methods include: manometry, EGG, insulin tests, NMR and expiratory tests. To date, the problem has been managed symptomatically; in special cases, surgical interventions have been required. Conclusions. At present, a wide array of treatment options is available, including new forms of drugs and less radical surgical procedures carried out in numerous centres worldwide.