Study of small intestinal structural and functional changes in patients with diabetes mellitus

ABSTRACT

Small intestinal structural and functional changes were studied in 20 IDDM patients, 20 NIDDM patients and 10 normal controls. Diarrhea was the most common gastrointestinal symptom, affecting 55% of patients of IDDM group and 40% of patients of NIDDM group. Manifestations of autonomic neuropathy were present in 55% of IDDM group and 40% of NIDDM group, and a statistically significant association was found between the presence of autonomic manifestations and the presence of diarrhea and constipation. D-xylose absorption excretion was normal in 75% of patients of each diabetic group and was reduced in the remaining 25% of patients. Histopathological examination of the jejunal mucosa showed villi of normal shape in all patients who had normal D-xylose excretion, and were abnormally clubbed and stunted with decreased cryptovillous ratio and increased goblet cells in all patients with reduced D-xylose excretion. Histochemical examination showed that alkaline phosphatase and succinic dehydrogenase activity were reduced in all patients with abnormal villi and reduced D-xylose excretion, and were dependent on the control status of diabetes mellitus in patients with normal villi, with significant increase in alkaline phosphatase activity and decrease in succinic dehydrogenase activity in uncontrolled cases