Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease,and other co-morbidities.Gastrointestinal(GI) involvement can ...Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease,and other co-morbidities.Gastrointestinal(GI) involvement can present with esophageal dysmotility,gastro-esophageal reflux disease(GERD),gastroparesis,enteropathy,non alcoholic fatty liver disease(NAFLD) and glycogenic hepatopathy.Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors.Diabetic gastroparesis manifests as early satiety,bloating,vomiting,abdominal pain and erratic glycemic control.Gastric emptying scintigraphy is considered the gold standard test for diagnosis.Management includes dietary modifications,maintaining euglycemia,prokinetics,endoscopic and surgical treatments.Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures.NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment ismainly lifestyle measures,with diabetes and dyslipidemia management when coexistent.Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment.Though GI complications of diabetes are relatively common,awareness about its manifestations and treatment options are low among physicians.Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient.This review is an update on the GI complications of diabetes,their pathophysiology,diagnostic evaluation and management.展开更多
Abdominal pain is the most common symptom of chronic pancreatitis(CP)and is often debilitating for patients and very difficult to treat.To date,there exists no cure for the disease.Treatment strategies focus on sympto...Abdominal pain is the most common symptom of chronic pancreatitis(CP)and is often debilitating for patients and very difficult to treat.To date,there exists no cure for the disease.Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events.Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain.The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders,exocrine pancreatic insufficiency,mineral bone disease,frailty,and malnutrition,are in its early stages.Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain,as well as to improve pain management.Despite the array of tools available,many therapeutic options for the management of CP pain provide incomplete relief.There still remains much to discover about the neural regulation of pancreas-related pain.In this review,we will discuss research from the last 5 years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain.These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management,and identification of potential future therapies.展开更多
文摘Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease,and other co-morbidities.Gastrointestinal(GI) involvement can present with esophageal dysmotility,gastro-esophageal reflux disease(GERD),gastroparesis,enteropathy,non alcoholic fatty liver disease(NAFLD) and glycogenic hepatopathy.Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors.Diabetic gastroparesis manifests as early satiety,bloating,vomiting,abdominal pain and erratic glycemic control.Gastric emptying scintigraphy is considered the gold standard test for diagnosis.Management includes dietary modifications,maintaining euglycemia,prokinetics,endoscopic and surgical treatments.Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures.NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment ismainly lifestyle measures,with diabetes and dyslipidemia management when coexistent.Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment.Though GI complications of diabetes are relatively common,awareness about its manifestations and treatment options are low among physicians.Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient.This review is an update on the GI complications of diabetes,their pathophysiology,diagnostic evaluation and management.
文摘Abdominal pain is the most common symptom of chronic pancreatitis(CP)and is often debilitating for patients and very difficult to treat.To date,there exists no cure for the disease.Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events.Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain.The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders,exocrine pancreatic insufficiency,mineral bone disease,frailty,and malnutrition,are in its early stages.Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain,as well as to improve pain management.Despite the array of tools available,many therapeutic options for the management of CP pain provide incomplete relief.There still remains much to discover about the neural regulation of pancreas-related pain.In this review,we will discuss research from the last 5 years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain.These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management,and identification of potential future therapies.
