Anorectal dysfunction in diabetic autonomic neuropathy and microangiopathy

ABSTRACT

Diabetic autonomic neuropathy affects many physiological systems, producing a variety of important clinical manifestations. Diabetic motility disturbances are frequent and may be found within esophagus, stomach, small bowel, colon and anal sphincter. Disturbed motility may explain gastrointestinal symptoms of patients with diabetic enteropathy. The aim of this study was to investigate any possible relation between the severity of anorectal dysfunctions in diabetes mellitus and the duration of the disease and the presence of microangiopathy or neuropathy. The present study comprised 47 diabetic male patients and ten healthy male volunteers as control group. The patients and control were subjected to history taking, clinical examination [including autonomic function tests and occular fundoscopy], and a series of investigations including laboratory, sigmoidoscopy with mucosal biopsy and lastly anorectal manometry. The majority of diabetic noncomplicated patients were found to be asymptomatic [73%]. While, conistipation was the most common among symptomatic diabetic patients whether complicated [41%] or noncomplicated [20%], incontinence was frequent in autonomic neuropathy [28%]. Complicated diabetic patients exhibited decreased resting anal pressure [P=0.027], squeeze pressure [P=0.017], and higher thresholds of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to diabetic non complicated cases. Diabetic patients with long history of the disease [>5years] had more worsening of the resting anal pressure [P=0.001], anal squeeze pressure [P=0.001] and more impairment of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to those with short history. In patients with long history of diabetes mellitus, anorectal motility disorders were observed frequently and could be attributed to the increased incidence of microangiopathy, autonomic and peripheral neuropathy observed in this subset of patients. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea and sometimes incontinence. Anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful in early recognition of gastrointestinal motility disorders and subsequently better long-term management of patients with diabetes mellitus