Diabetes and the gastrointestinal tract

Gastrointestinal (GI) complications of diabetes mellitus are common and result in a significant diminution in health-related quality of life. Diabetes can affect almost every part of GI tract from the oesophagus to the rectum, and causes a variety of symptoms including reflux, heartburn, nausea, vomiting, abdominal pain, diarrhoea and constipation. Diabetes-induced GI complications are collectively referred to as diabetic enteropathy. Over recent years, the investigation of the underlying pathogenesis of diabetes-induced GI complications has provided objective evidence of abnormalities in the enteric nervous system, which is essential for normal motility within the GI tract. The diagnosis of diabetic enteropathy is complex, and other causes of GI symptoms should be excluded. There is currently no cure for diabetic enteropathy. Hence, the goals of treatment are to slow progression, relieve symptoms and manage complications. Key to this is tight glycaemic control, dietary advice and occasionally pharmacological treatment with, for example, prokinetics.