Management of diabetic enteropathy

Gastrointestinal symptoms are frequently encountered in patients with diabetes mellitus. Symptoms may relate to any region of the alimentary tract; the common ones are heartbum, nausea, vomiting, diarrhea, constipation, fecal incontinence, and abdominal pain. These manifestations are most often reported in patients with advanced insulin-dependent diabetes mellitus and clinical evidence of neuropathy. The pathogenetic mechanisms include abnormal extrinsic neural control of motor function and altered enterocyte absorption. This article reviews practical approaches to the identification of the pathophysiologic mechanisms involved in diabetic enteropathies and their complications such as bacterial overgrowth, and briefly outlines treatment strategies. Particular emphasis is placed on noninvasive quantitative scintigraphy, choice of prokinetic therapy (e.g., cisapride, erythromycin, octreotide), and the current role of pancreatic transplantation.