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World J Diabetes. Jun 15, 2021; 12(6): 794-809
Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.794
Diabetic gastroenteropathy: An underdiagnosed complication
Marcio José Concepción Zavaleta, Jhean Gabriel Gonzáles Yovera, Diego Martín Moreno Marreros, Luciana del Pilar Rafael Robles, Kely Roxana Palomino Taype, Karen Nohelly Soto Gálvez, Luis Fernando Arriola Torres, Julia Cristina Coronado Arroyo, Luis Alberto Concepción Urteaga
Marcio José Concepción Zavaleta, Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima 12590, Peru
Jhean Gabriel Gonzáles Yovera, Division of Gastroenterology, Hospital Nacional Guillermo Almenara Irigoyen, Lima 12590, Peru
Diego Martín Moreno Marreros, Division of Medicine, Universidad Nacional de Trujillo, Trujillo 13011, Peru
Luciana del Pilar Rafael Robles, Division of Endocrinology, Hospital Nacional Dos de Mayo, Lima 150101, Peru
Kely Roxana Palomino Taype, Division of Endocrinology, Instituto de Neurología y Endocrinología Avanzada, Andahuaylas 03700, Peru
Karen Nohelly Soto Gálvez, Clinical Management Unit, Hospital Nacional Guillermo Almenara Irigoyen, Lima 12590, Peru
Luis Fernando Arriola Torres, Division of Neurology, Instituto de Neurología y Endocrinología Avanzada, Andahuaylas 03700, Peru
Julia Cristina Coronado Arroyo, Division of Obstetrics and Gynaecology, Clínica Vesalio, Lima 15036, Peru
Luis Alberto Concepción Urteaga, Division of Neumology, Hospital Regional Docente de Trujillo, Trujillo 13011, Peru
Author contributions: Concepción Zavaleta MJ and Gonzáles Yovera JG were the main writer and performed literature overview; Moreno Marreros DM was reviewer, translator, and prepared the manuscript; Rafael Robles LP conceived and designed the study, and was reviewer; Palomino Taype KR, Soto Galvez KN and Arriola Torres LF performed written contribution to body of text; Coronado Arroyo JC and Concepción Zavaleta LA performed literature overview and were reviewers; All authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Diego Martín Moreno Marreros, MD, Research Associate, Division of Medicine, Universidad Nacional de Trujillo, Fco. Adrianzen 312 Urb. Santa María, Trujillo 13011, Peru. diegomorenosud@hotmail.com
Received: January 14, 2021
Peer-review started: January 14, 2021
First decision: February 12, 2021
Revised: February 28, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: June 15, 2021
Processing time: 140 Days and 20.1 Hours
Abstract

This article is an extensive review that provides an update on the pathophysiology, symptoms, diagnosis, and treatment of diabetic gastroenteropathy. There is no reported prevalence, but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%, and type 2 patients, 1%. Also, in the group of type 1 diabetes, it has been observed that women are more likely to present this condition (5.8% vs 3.5%). Many factors are associate with its development (e.g., hyperglycemia, vagal dysfunction, loss of expression of neural nitric oxide synthase in the myenteric plexus, alterations in the Cajal interstitial cell network, and oxidative stress). Gastrointestinal discomfort could be perceived 70% higher in diabetic patients, describing that 25% of diabetic patients experience gastrointestinal symptoms. Diabetic enteropathy could affect any portion of the gastrointestinal tract, but esophageal alterations were described in more than 60% of diabetic patients, also 60% of them present constipation, and 20%, diarrhea. Gastric emptying scintigraphy is useful to evaluate gastroparesis, therefore, gastric retention of more than 60% at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis; however, other studies such as breath tests, with a sensitivity of 89% and a specificity of 80%, or the endoscopic capsule contribute to the diagnosis. There is no cure; however, management must be multidisciplinary, focused on slowing the progression of diabetic gastroenteropathy, reducing symptoms, and restoring function; that includes nutritional recommendation, maintain glucose levels kept below 180 mg/dL, use of prokinetics, anti-emetics; nowadays, it has been special interest in surgical treatment, such as pyloroplasty, also gastric electrical stimulation appears to be another alternative.

Keywords: Gastroenteropathy; Gastroparesis; Diabetes mellitus; Complication; Gastrointestinal disease; Treatment

Core Tip: Diabetic gastroenteropathy is a common complication, poorly diagnosed in patients with long-term disease. These can present esophageal, gastric, intestinal, and even anorectal symptoms. Gastrointestinal Symptom Severity Index, Gastroparesis Cardinal Symptom Index, and Assessment of Constipation Quality of Life scores, as well as symptomatic assessment scales, contribute to the diagnosis. Apart from gastric emptying scintigraphy, currently, the use of endoscopic capsules has allowed the evaluation of abnormal transit. Jejunal fluid aspiration and culture allow assessment of bacterial overgrowth. Medical treatment, as well as adequate glycemic control, improve the symptoms, and delay the progression of the disease; in selected patients, pyloroplasty and gastric electrical stimulation are useful.