Abstract
Gastrointestinal problems in diabetes mellitus include esophageal reflux, gastroparesis, diarrhea, constipation and possibly biliary tract abnormalities. In addition, abnormal gastrointestinal motility has been associated with poor glycemic control. This article reviews these complications including pathophysiology, epidemiology, clinical presentation and treatment. Factors in treating esophageal reflux in patients with diabetes are considered. Treatment options for gastroparesis are compared, including use of prokinetic agents (cisapride, metoclopramide, erythromycin and domperidone), antiemetic agents and combination therapy. Clinical trials, adverse effects, drug-drug interactions, and costs of the prokinetic agents are compared. Pharmacological management of diabetic diarrhea, including use of antimicrobial therapy, clonidine and octreotide, is discussed. Some considerations in treating constipation in patients with diabetes are reviewed.
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