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Curr Treat Options Gastroenterol
2017[Dec]; 15
(4
): 460-474
PMID29063998
show ga
Diabetes mellitus (DM) can affect the structure and function of the colon
promoting commonly encountered lower gastrointestinal symptoms such as
constipation, diarrhea, abdominal distention, bloating, and abdominal pain.
Specific colonic disorders for which adults with DM are at greater risk include
chronic constipation, enteropathic diarrhea, colorectal cancer (CRC),
inflammatory bowel disease, microscopic colitis, and Clostridium difficile
colitis. Smooth muscle structure and function, density of the interstitial cells
of Cajal, and the health and function of the autonomic and enteric nerves of the
colon are all potential affected by DM. These effects can in turn lead to
alterations in colon motility, visceral sensation, immune function, endothelial
function, and the colonic microbiome. The evaluation and treatment for slow
transit constipation as well as pelvic floor dysfunction should be considered
when constipation symptoms are refractory to initial treatment measures.
DM-related medications and small bowel conditions such as celiac disease and
small intestinal bowel overgrowth should be considered and excluded before a
diagnosis of enteropathic diarrhea is made. Given the higher risk of CRC, adults
with DM should be appropriately screened and may require a longer bowel
preparation to ensure an adequate evaluation.
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