Fibre-optic endoscopic study of the upper gastrointestinal tract in patients with diabetic keto-acidosis

ABSTRACT

Fifteen diabetic patients complicated with ketoacidosis complaining of various upper gastrointestinal symptoms, shortly before and during the attack and ten controlled diabetic patients were studied by fibreoptic endoscopy and biopsies were taken for histology and histochemical study. Radiology with barium for upper gastrointestinal tract was done. The results revealed occult blood and manifested in the stool of 5 patients. The endoscopic examination showed normal findings in two patients and different abnormalities in the motility as hyperperistalsis, incompetent esophago-gastrie function, pylorus or pylorospasms and biliary reflux. Structural macosal abnormality varies from hyperaemia, oedema, erosions and even acute ulceration of the esophagus, stomach and duodenum. Candida infection of the esophagus was present in one patient. The histopathology and histochemistry of mucosal biopsy revealed marked inflammatory reactions, with increased histochemical activity of acid phosphatase enzyme. Ten days after controlling the keto-acidosis most of these changes subsided and gastrointestinal symptoms improved. There was a relation between the severity of ketoacidosis and the extent in the pathological changes in motility and structural changes. These changes of upper gastrointestinal tract functions or structure may be attributed to the metabolic derangement, presence of ketonemia and ketoacidosis as well as the electrolyte disturbances