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- July 4, 2008 |
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"Diabetic Autonomic Neuropathy: GI Tract: DX and RX - Conclusions of a Careful Clinician or Frustrations of an Impatient Patient"Dr. Terry Moore (biography)
English - 2006-04-28 - 38 minutes
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Summary :
Gastrointestinal (GI) complaints are common in diabetic patients, and in this presentation Dr. Moore discusses the more common GI symptoms in diabetes and their underlying mechanisms, as well as diagnostic and therapeutic approaches.
Diabetic patients may experience upper GI symptoms such as epigastric fullness, nausea and heartburn, and lower GI symptoms such as constipation, diarrhea and fecal incontinence.
Delayed gastric emptying is seen in about 50 percent of diabetic patients, is commoner in women, gets worse with hyperglycemia, and the symptoms tend to be fullness and bloating rather than nausea and vomiting. Dr. Moore talks about the mechanisms of diabetic gastric dysmotility involving intrinsic neuropathy, "auto-vagotomy", hyerglycemia, hormonal control, psychological factors and medications.
In terms of the long term treatment of diabetic gastropathy, Dr. Moore talks about the role of diet, prokinetic drugs (1), tricyclic antidepressants (2), endoscopy, and novel approaches such as botulinum toxin injection of the pylorus (3) and gastric electrical stimulation (4). The management of acute gastroparesis is also discussed.
Lower GI symptoms are also common in diabetic patients (5). Dr. Moore discusses the etiology and treatment of diabetic diarrhea and constipation, talks a bit about gas and fecal incontinence, and ends with some concluding comments.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The upper and lower gastrointestinal symptoms that are more common in diabetes
- The mechanisms especially the neuropathies, that promote these symptoms
- Based on these mechanisms, a diagnostic and therapeutic approach to GI symptoms in the diabetic patient
Bibliographic references :
1. J Arts, P Caenepeel, K Verbeke and J TackInfluence of erythromycin on gastric emptying and meal related symptoms in functional dyspepsia with delayed gastric emptying Gut 2005;54:455-460.
2. Prakash C, Lustman PJ, Freedland KE, Clouse RE.Tricyclic Antidepressants for Functional Nausea and Vomiting (Clinical Outcome in 37 Patients) Dig Dis Sci. 1998 Sep;43(9):1951-6.
3. Brian E. Lacy, PHD, MD, Michael D. Crowell, PHD, Ann Schettler-Duncan, RN, Carole Mathis, PHD and Pankaj J. Pasricha, MDThe Treatment of Diabetic Gastroparesis With Botulinum Toxin Injection of the Pylorus Diabetes Care 27:2341-2347, 2004.
4. Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, Lindberg G, Konturek J, Nowak T, Quigley EM, Tougas G, Starkebaum W.Gastric electrical stimulation for medically refractory gastroparesis Gastroenterology. 2003 Aug;125(2):421-8.
5. Celik AF, Osar Z, Damci T, Pamuk ON, Pamuk GE, Ilkova H. "How important are the disturbances of lower gastrointestinal bowel habits in diabetic outpatients?" Am J Gastroenterol. 2001 Apr;96(4):1314-6.
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