Diagnosis and Treatment of Gastrointestinal System Autonomic Neuropathy

Year 2017, Volume: 5 Issue: 4, 60 - 62, 10.04.2017

Doç. Dr. Feray Akbaş

Abstract

Abstract

Gastrointestinal autonomic neuropathy is one of the most common clinical problemsin diabetic patients. It might cause fluctutations in blood glucosel evels and a decresa-se inquality of life. It represents as delayed gastric emptying (gastroparesis), dysphagia, earlysatiety, nausea, vomiting (decreased motility), delayed food absorption, constipation (atonic colon), night diarrhoea, cholecystitis and biliary sludge (atonic gall bladder). Diagnosis is made by scintigraphic evaluation of GIS motility, radio-opaquemarkers, gastric emptying breath testing and wireless motilitycapsule. Treatment methods are; diabetes regulation, dietary changes (avoiding excess fat and fiber, more frequent eating inlesseramounts), medications (Gastroparesis: metoclopramide, domperidone, eritromisin Constipation: Laxatives, Prucalopride, Linaclotide, Pyridostigmine Diarrhoea: Loperamide, antibiotherapy Abdominalpain: Antidepressants) and GI stimulation. Questioningthe symptoms of GIS autonomic neuropathy symptoms in diabetic patient sand puttin geffort for the treatment will help this important morbidity toresolv eandim provequalityof life.

Keywords

Diabetes mellitus, autonomic neuropathy, gastrointestinal system

Gastrointestinal Sistem Otonom Nöropatinin Tanı ve Tedavisi

Abstract

Öz

Gastrointestinal otonom nöropati diyabetik hastalarda kliniğe en fazla yansıyan sorunlardan biridir. Kan şekerinde dalgalanmalara ve yaşam kalitesinde azalmaya nedenolabilir. Kendini mide boşalmasında gecikme (gastroparezi), yutma güçlüğü, çabuk doyma, bulantı, kusma (motilite azalması), alınan gıdaların emiliminin gecikmesi konstipasyon (kolon atonisi), gece diyareleri, kolesistit ve safra çamuru (safra kesesi atonisi) şeklinde gösterebilir. Tanı yöntemleri; klinik şüphe sonrası Gİ motilitenin sintigrafik değerlendirmesi, radyo-opak belirteçler, gastrik boşalma nefes testi ve “wireless” motilite kapsülünün kullanımını içerir.Tedavide kan şekeri regülasyonu, diyet tedavisi (az ve sık beslenme, fazla yağ ve lif içeriğinden kaçınmak), ilaç tedavisi (Gastroparezi: metoklopramid, domperidon, eritromisin; Konstipasyon: Laksatifler, Prucalopride, Linaclotide, Pyridostigmine; Diyare: Loperamide, antibiyoterapi; Karın ağrısı: Antidepresanlar); ve GIstimülasyonkullanılır. Diyabetik hastalarda önemli bir morbidite nedeni olan GIS otonom nöropatisemptomlarınınciddiye alınarak sorgulanması ve tedavi için çaba harcanması, diyabetik hastaların yaşam kalitesini önemli derecede arttıracaktır.

Keywords

Diyabetes mellitus, otonom nöropati, astrointestinal sistem

References

• Kaynaklar 1.Harrison's Principles of InternalMedicine, 19th Edition TextbookPart16 EndocrinologyandMetabolism. Page 2426. 2015 byMcGraw-HillE-ducation.US 2.Gatopoulou A, Papanas N, Maltezos E. Diabetic gastrointestinal autono-mic neuropathy: current status and new achievements for everyday clini-cal practice.Eur J Intern Med. 2012 Sep;23(6):499-505. 3.Otonom Nöropati. DM Çalışma ve Eğitim Grubu. TEMD Diabetes Mellitusve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2016. Sayfa:146 4.Türkiye Diyabet Programı 2015-2020. TC Sağlık Bakanlığı Türkiye HalkSağlığı Kurumu. (cited March 2017) Avaliable at:http://diyabet.gov.tr/in-dex.php?lang=tr&page=94&newsCat=1&newsID=48 5.Kempler P, Várkonyi T, Körei AE, Horváth VJ. Gastrointestinal auto-nomic neuropathy in diabetes: the unattended borderline between dia-betology and gastroenterology.Diabetologia. 2016 Mar;59(3):401-3. 6.Feldman M, Schiller LR. Disorders of gastrointestinalmotilityassocia-tedwithdiabetesmellitus. AnnInternMed 1983; 98:378. 7.Parkman HP, Hasler WL, Fisher RS, AmericanGastroenterologicalAsso-ciation. AmericanGastroenterologicalAssociationtechnicalreview on the-diagnosisandtreatment of gastroparesis. Gastroenterology 2004; 127:1592. 8.Choung RS, Locke GR 3rd, Schleck CD, et al. Risk of gastroparesis insubjectswithtype 1 and 2 diabetes in the general population. Am J Gas-troenterol 2012; 107:82. 9.Janatuinen E, Pikkarainen P, Laakso M, Pyörälä K. Gastrointestinalsymp-toms in middle-ageddiabeticpatients. Scand J Gastroenterol 1993; 28:427. 10. Rayner CK, Samsom M, Jones KL, Horowitz M. Relationships of upper-gastrointestinal motor andsensoryfunctionwithglycemiccontrol. Diabe-tesCare 2001; 24:371. 11.Inadomi JM, Jamal R, Murata GH, et al. Step-downmanagement of gas-troesophagealrefluxdisease. Gastroenterology 2001; 121:1095. 12. DeVault KR, Castell DO, AmericanCollege of Gastroenterology. Upda-ted guidelines for the diagnosis and treatment of gastroesophageal refluxdi-sease. Am J Gastroenterol 2005; 100:190. 13. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. LifestyleIntervention in Gastroesophageal Reflux Disease. ClinGastroenterolHepatol 2016; 14:175. 14. Guerci B, Bourgeois C, Bresler L, Scherrer ML, Böhme P. Gastric elect-rical stimulation for the treatment of diabetic gastroparesis. Diabetes Me-tab. 2012 Nov;38(5):393-402. 15. Rayner CK, Horowitz M. Gastrointestinal motilityandglycemiccontrolin diabetes: thechickenandtheeggrevisited? J ClinInvest 2006;116:299. 16. Rayner CK, Samsom M, Jones KL, Horowitz M. Relationships of upper-gastrointestinal motor andsensoryfunctionwithglycemiccontrol. Diabe-tesCare 2001; 24:371. 17. Bharucha AE, Batey-Schaefer B, Cleary PA, et al. DelayedGastricEmpt-ying Is AssociatedWithEarlyandLong-termHyperglycemia in Type 1 Dia-betesMellitus. Gastroenterology 2015; 149:330. 18. Özgen AG, Aydın A, Kayalıoğlu M, Yılmaz C, Kumanlıoğlu K, KabalakT, Tüzün M: Diabetik otonom nöropatinin tanısında mide ve mesane bo-şalımının sintigrafik yöntemle değerlendirilmesi. Turk JGastroenterohe-patol 1995; 6:245-249. 19.Patterson D, Abell T, Rothstein R, et al. A double-blindmulticentercompari-son of domperidoneandmetoclopramide in thetreatment of diabeticpatients-withsymptoms of gastroparesis. Am J Gastroenterol 1999; 94:1230. 20.Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastricempt-ying in diabeticgastroparesisbyerythromycin. Preliminary studies. N EnglJ Med 1990; 322:1028. 21.Schuurkes J. Effect of cisapride on gastricmotility. Z Gastroenterol 1990;28 Suppl1:27. 22.von der Ohe MR. Diarrhoea in patients with diabetes mellitus. Eur J Gas-troenterolHepatol 1995; 7:730. 23.Duchen LW, Anjorin A, Watkins PJ, Mackay JD. Pathology of autonomicneuropathy in diabetes mellitus. Ann Intern Med 1980; 92:301. 24.Wald A. Incontinence and anorectal dysfunction in patients with diabe-tes mellitus. Eur J GastroenterolHepatol 1995; 7:737. 25.Bytzer P, Talley NJ, Jones MP, Horowitz M. Oral hypoglycaemic drugsand gastrointestinal symptoms in diabetes mellitus. Aliment PharmacolT-her 2001; 15:137. 26.Valdovinos MA, Camilleri M, Zimmerman BR. Chronic diarrhea in dia-betes mellitus: mechanisms and an approach to diagnosis and treatment.Mayo ClinProc 1993; 68:691. 27.Søfteland E, Brock C, Frøkjær JB, Simrén M, Drewes AM, DimcevskiG. Rectal sensitivity in diabetes patients with symptoms of gastropare-sis. J Diabetes Res. 2014;2014:784841. 28.Søfteland E, Brock C, Frøkjær JB, Brøgger J, Madácsy L, Gilja OH, Arendt-Nielsen L, Simrén M, Drewes AM, Dimcevski G. Association between vis-ceral, cardiac and sensorimotor polyneuropathies in diabetes mellitus. J Dia-betes Complications. 2014 May-Jun;28(3):370-7. 29.Yarandi SS, Srinivasan S. Diabetic gastrointestinal motility disorders andthe role of enteric nervous system: current status and future directions.Neu-rogastroenterolMotil. 2014 May;26(5):611-24. 30.Azpiroz F, Malagelada C. Diabetic neuropathy in the gut: pathogene-sis and diagnosis.Diabetologia. 2016 Mar;59(3):404-8. 31.Brock C, Brock B, Pedersen AG, Drewes AM, Jessen N, Farmer AD. As-sessment of the cardiovascular and gastrointestinal autonomic compli-cations of diabetes. World J Diabetes. 2016 ;7(16):321-32. 32. Törnblom H. Treatment of gastrointestinal autonomic neuropathy.Dia-betologia. 2016 ;59(3):409-13.