| Abstract |
A wide variety of gastrointestinal abnormalities in any part of the digestive system can occur with Diabetes Mellitus (DM). Although symptoms may be subclinical , severe and life -threatening problems can occur. Manifestations of diabetic dysmotility may represent the underlying motor abnormality or result from secondary metabolic derrangements. The pathogenesis for motility disorders in diabetes remains unclear. The aim of the study was to assess the different factors of esophageal and anorectal function in a series of consecutive , unselected diabetic patients who attended the outpatients clinic irrespective of the presence or absence of esophageal and anorectal disorders and to correlate the findings to the duration of the disease and the presence of autonomic or peripheral neuropathy and microangiopathy. Method: Standard multiport esophageal manometry, 24h esophageal manometry and pH monitoring were performed in 20 healthy controls and 38 patients with Diabetes Mellitus. Patients were divided into two groups, according to the duration of the disease : group with a short duration (7.2+2.5 SDyrs ; 8 males and 11 females ; age : 57+18 SDyrs) and group with significantly (p<0.001) longer duration (15.8+5.6 SDyrs ; 6 males and 13 females ; age : 62+15 SDyrs). Another group of 25 healthy controls (10 males and 15 females ; age : 62+14 SDyrs) and the two groups of patients had a standard multiport anorectal manometry carried out. Results: Patients with long standing DM (>10 years), showed lower amplitude (p<0.01), duration (p<0.05), velocity (p<0.05) and strength of peristalsis (p<0.05) as compared to controls. The same group of patients showed lower amplitude (p<0.01) and strength of esophageal peristalsis (p<0.05) as compared to the group with a short duration of the disease (<10 years). Patients with long standing DM, demonstrated a lower incidence of effective peristaltic contractions on the 24h esophageal manometry (p<0.05) as compared to controls and a higher incidence of simultaneous contractions (p<0.05). Patients showed significantly increased incidence of Gastroesophageal Reflux Disease (p<0.05), especially the group with long standing disease. As regards to the results of the anorectal manometry, patients showed lower resting and squeeze anal pressures (p<0.01 ), impaired rectoanal inhibitory (RAIR) and ano-cutaneous reflexes (ACR), and reduced sensitivity in rectal distention ( p=0.004 ) as compared to controls. In addition, the group with long standing disease showed a significantly increased incidence of microangiopathy (p=0.04 ) and autonomic and peripheral neuropathy ( p=0.002 ), significantly reduced basal and squeeze anal pressures (52+16SDmmHg vs 64+24SDmmHg ; p=0.03 and 98+39SDmmHg vs124+54SDmmHg ; p=0.04 respectively) , reduced amplitude of slow waves (7.3+3SDmmHg vs 9.5+3.7SDmmHg ; p=0.03), anal leak in smaller rectal volumes p=0.003) and reduced response of the anal sphincter at the ACR (29+14SDmmHg vs 39+14SDmmHg ; p=0.05), as compared to the group with short duration of diabetes. The former group of patients exhibited a significantly higher incidence of faecal incontinence (p=0.008). Conclusion: Patients with long standing DM, present with severely impaired function of the esophagus and both of the anal sphincters and the rectum. These findings could be attributed to the increased incidence of microangiopathy and autonomic and peripheral neuropathy observed in this subset of diabetic patients.
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Κινητικές διαταραχές του οισοφάγου και της ορθοπρωκτικής περιοχής στους ασθενείς με Σακχαρώδη Διαβήτη, παράλληλα με τη διάρκεια της νόσου
