Diabetic Gastroenteropathy: A Complication of Diabetes Mellitus

Alvin Hartanto Kurniawan, Benedictus Hanjaya Suwandi, Ulfa Kholili


Diabetic gastroenteropathy is a common complication in prolonged diabetic patients, particularly patients with poor glycemic control or other complications, including all form of diabetic complication on the gastrointestinal tract, which prompts various symptoms of heartburn, abdominal pain, nausea, vomiting, even constipation, diarrhea, and fecal incontinence. The underlying pathophysiology of this complication manifestations are different on each organ or symptom, but may include autonomic nervous system neuropathy, loss of Interstitial Cell of Cajal as gastric muscle pacemaker leading to dysmotility, impair of liquid transportation and motoric function, as well as hyperglycemia causing oxidative stress, and other factors like Insulin-Growth Factor I inducing smooth muscle atrophy. Diabetic gastroenteropathy is one of major morbidity on diabetes mellitus patients. Patients with this complication need to be well diagnosed and ruled out other diagnosis possibilities. Management of the complication includes resolving main symptoms and maintaining good glycemic control. With growing number of diabetes mellitus patients and the prevalence of diabetic gastroenteropathy complication not being well recorded, caused by lack of attention and knowledge of healthcare provider in identifying the complication; it is important to be able to identify and to give early treatment to diabetic gastroenteropathy patients, to increase quality of life and maintain glycemic control of the patient.


Diabetes Mellitus; Gastroenteropathy; Complication; Gastroparesis


Yarandi SS, Srinivasan S. Diabetic gastrointestinal motility disorders and the role of enteric nervous system: Current status and future directions. Neurogastroenterology and Motility. 2014; 26(5):611-24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104990/

Rodrigues ML, Motta ME. Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus. J de Pediatria. 2012;88(1):17-24. https://www.ncbi.nlm.nih.gov/pubmed/22344626

Camilleri M. Clinical practice. Diabetic gastroparesis. New Engl J Med. 2007;356(8):820-9. https://www.ncbi.nlm.nih.gov/pubmed/17314341.

International Diabetes Federation. IDF diabetes atlas. 8th ed. Brussel: International Diabetes Federation; 2017.

Maleki D. Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. JAMA. 2000;160(18):2808-16. https://www.ncbi.nlm.nih.gov/pubmed/11025791.

Gustaffson RJ. Esophageal dysmotility is more common than gastroparesis in diabetes mellitus and is associated with retinopathy. Rev Diab Studies. 2011; 8(2):268–75. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280012/.

Wang X. Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy. World J Gastroenterol. 2008;14(5): 709-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683996/.

Foris LA, Bhimji SS. Diabetic gastroparesis. Grenada: Stat Pearls Publishing; 2017.

Aljarallah BM. Management of diabetic gastroparesis. Saudi J Gastroenterol. 2011;17(2):97-104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099072/.

Krishnan B. Gastrointestinal complications of diabetes mellitus. World J Diab. 2013;4(3):51-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680624/.

Khoshbaten M. Gastrointestinal signs and symptoms among persons with diabetes mellitus. Gastroenterology and Hepatology from Bed to Bench. 2011;4(4):219-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017431/.

Callaghan BC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane database systematic review. 2012;6: CD007543. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048127/.

Podolsky DK. Yamada’s textbook of gastroenterology. Chicester: John Wiley & Sons, Ltd; 2016.

Ordog T, Hayashi Y, Gibbons SJ. Cellular pathogenesis of diabetic gastroenteropathy. Minerva Gastroenterol Dietol J. 2009;55(3):315-343. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854169/.

Ordog T. Interstitial cells of Cajal in diabetic gastroenteropathy. Neurogastroenterol Motility. 2008;20(1):8-18. https://www.ncbi.nlm.nih.gov/pubmed/18173559.

Lee HT. The mechanism and spread of pacemaker activity through myenteric interstitial cells of Cajal in human small intestine. Gastroenterol. 2007; 132(5):1852-965. https://www.ncbi.nlm.nih.gov/pubmed/17484879.

Lin HZ. Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis. Neurogastroenterol Motility. 2010;22(1):56-61. https://www.ncbi.nlm.nih.gov/pubmed/19614868.

Camilleri M. Gastrointestinal problems in diabetes. Endocrinol Metab Clin North Am. 1996;25(2):361-78. https://www.ncbi.nlm.nih.gov/pubmed/8799704.

Bytzer P. GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol. 2002;97(3):604-11. https://www.ncbi.nlm.nih.gov/pubmed/11922554.

Maisey A. A practical approach to gastrointestinal complications of diabetes. Diab Ther. 2016;7(3):379-86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014788/.

Rayner CK. Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diab Care. 2001;24(2):371-81. https://www.ncbi.nlm.nih.gov/pubmed/11213895.

Saeed A. Fungal esophagitis in a child with insulin dependent diabetes mellitus. J Coll Physic Surg Pakistan. 2016;26(8):712-13. https://www.ncbi.nlm.nih.gov/pubmed/27539771

Frøkjær JB. Impaired contractility and remodeling of the upper gastrointestinal tract in diabetes mellitus type-1. World J Gastroenterol. 2007;13(36):4881-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4611767/.

Lee SD. Gastroesophageal reflux disease in type 2 diabetes mellitus with or without peripheral neuropathy. Neurogastroenterol Motility. 2011;17(3): 274-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155063/.

Wilcox CM. Infectious esophagitis. Gastroenterol Hepatol. 2006;2(8):567-568. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350250/.

Vandenplas Y. Gastroesophageal reflux in children. Brussel: Springer International Publishing; 2017.

Chang CT. Improvement of esophageal and gastric motility after 2-week treatment of oral erythromycin in patients with non-insulin-dependent diabetes mellitus. J Diab Complications. 2003;17(3):141-4. https://www.ncbi.nlm.nih.gov/pubmed/12738398.

Hasler W. Gastroparesis. Curr Opin Gastroenterol. 2012;28(6):621-8. https://www.ncbi.nlm.nih.gov/pubmed/23041675

Parkman HP, Fass R, Foxx-Orenstein AE. Treatment of patients with diabetic gastroparesis. Gastroenterol Hepatol. 2010;6 (6 Suppl 9):1-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920593/.

Parkman HP. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol. 2011;9(12):1056-134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499102/.

Almogbel RA. Prevalence and risk factors of gastroparesis-related symptoms among patients with type 2 diabetes. Int J Health Sci. 2016;10(3):397-404. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003583/.

Boaz M. Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy. J Diab Compl. 2011;25(5):325-8. https://www.ncbi.nlm.nih.gov/pubmed/21813291.

Grover M. Cellular changes in diabetic and idiopathic gastroparesis. Gastroenterol. 2011;140(5):1575-1585. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081914/.

Ravella K, Yang H, Gangula PRR. Impairment of gastric nitrergic and NRF2 system in apolipoprotein E knockout mice. Dig Dis Sci. 2012;57(6):1504-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677538/.

Tougas G. Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol. 2000;95(1):78-86. https://www.ncbi.nlm.nih.gov/pubmed/10638563.

Abell T. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103(3):753-63. https://www.ncbi.nlm.nih.gov/pubmed/18028513.

Perri F et al. (13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): Toward standardization for testing gastric emptying of solids. Digestive and Liver Disease. 2010; 42(8): 549-553. https://www.ncbi.nlm.nih.gov/pubmed/20116352

Lee A, Wilding G, Kuo B. Variable abnormal physiological motility in the proximal upper gastrointestinal tract in gastroparesis. Neurogastroenterol Motility. 2012;24(7):652-e276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376693/.

Abrahamsson H. Treatment options for patients with severe gastroparesis. Gut. 2007;56(5):877-883. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1954884/.

Lee A, Kuo B. Metoclopramide in the treatment of diabetic gastroparesis. Expert Rev Endocrinol Metabolism. 2010;5(5):653-662. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027056/.

Schey R. Domperidone to treat symptoms of gastroparesis: Benefits and side effects from a large single-center cohort. Digest Dis Sci. 2016; 61(12):3545-51. https://www.ncbi.nlm.nih.gov/pubmed/27530760.

Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol. 2003;98(2):259-63. https://www.ncbi.nlm.nih.gov/pubmed/12591038.

Hasler WL. Gastroparesis-current concepts and considerations. Medscape J Med. 2008;10(1):16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/.

Mondal A. Coordination of motilin and ghrelin regulates the migrating motor complex of gastrointestinal motility in Suncus murinus. Am J Physiol. Gastrointest Liv Physiol. 2012;302(10):G1207-15. https://www.ncbi.nlm.nih.gov/pubmed/22383491.

Wo JM. Randomised clinical trial: ghrelin agonist TZP-101 relieves gastroparesis associated with severe nausea and vomiting--randomised clinical study subset data. Alimentary Pharmacology & Therapeutic. 2011;33(6):679-88. https://www.ncbi.nlm.nih.gov/pubmed/21214610.

Friedenberg FK. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103(2):416-23. https://www.ncbi.nlm.nih.gov/pubmed/18070232.

McCallum RW. Gastric electrical stimulation improves outcomes of patients with gastroparesis for up to 10 years. Clin Gastroenterol Hepatol. 2011;9(4):314-9.https://www.ncbi.nlm.nih.gov/pubmed/21185396.

Jones MP, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003; 98(10):2122-9. https://www.ncbi.nlm.nih.gov/pubmed/14572555.

Chandrasekharan B. Colonic motor dysfunction in human diabetes is associated with enteric neuronal loss and increased oxidative stress. Neurogastroenterol Motility. 2011;23(2):131-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020997/.

Noel RA. Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes. Diab Care. 2009;32(5):834-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671118/.

Ohlsson B. Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis. Diabetologia. 2006; 49(9):2010-4. https://www.ncbi.nlm.nih.gov/pubmed/16832660.

Lysy J, Israeli E, Goldin E. The prevalence of chronic diarrhea among diabetic patients. Am J Gastroenterol. 1999;94(8):2165-70. https://www.ncbi.nlm.nih.gov/pubmed/10445544.

Consoli A, Formoso G. Potential side effects to GLP-1 agonists: understanding their safety and tolerability. Expert Opinion on Drug Safety. 2015;14(2):207-18. https://www.ncbi.nlm.nih.gov/pubmed/25496749.

Russo A. Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitus. Diabetic Med. 2004;21(2):176-82. https://www.ncbi.nlm.nih.gov/pubmed/14984454.

Fillmann HS. Diabetes mellitus and anal sphincter pressures: an experimental model in rats. Dis Colon Rectum. 2007;50(4):517-22. https://www.ncbi.nlm.nih.gov/pubmed/17285232.

Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs. 2005;65(3):385-411. https://www.ncbi.nlm.nih.gov/pubmed/15669880.

Saberi H. Measurement of colonic transit time based on radio opaque markers in patients with chronic idiopathic constipation: A cross-sectional study. Iranian Red Crescent Med J. 2013;15(12):e16617. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955515/.

Bures J. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/.

Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Invest Drug. 2009;18(3):349-358. https://www.ncbi.nlm.nih.gov/pubmed/19243285

Gatopoulou A, Papanas N, Maltezos E. Diabetic gastrointestinal autonomic neuropathy: current status and new achievements for everyday clinical practice. Eur J Intern Med. 2012;23(6):499-505. https://www.ncbi.nlm.nih.gov/pubmed/22863425.

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