Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

ABSTRACT

Disturbed motility may explain gastrointestinal symptoms of patients with diabetic neuropathy. This study investigates the anorectal dysfunctions in diabetic autonomic neuropathy [DAN] and microangiopathy. The study includes 47 diabetic patients [group 1 30 non-complicated; group 2 17 complicated by DAN and microangiopathy] and 10 healthy non-diabetic volunteers as control subjects. Following medical history, clinical examination and laboratory investigations, the included patients were subjected to sigmoidoscopy with mucosal biopsy and anorectal manometry. The lower gastrointestinal symptoms [e.g., constipation, diarrhoea or faecal incontinence] were reported more in group 2 [complicated diabetic patients] than in group 1 [non-complicated diabetic patients] [p=0.003]. Group 2 patients had significantly higher fasting blood glucose, serum uric acid, serum creatinine and triglycerides than group 1 patients [p=0.001, 0.03, 0.04,<0.001, respectively]. Overall, diabetic patients had lower resting anal pressure [p=0.004], squeeze pressure [p=0.007], and higher thresholds of minimal rectal sensation and sense of desire for defaecation [all p<0.001] when compared to control subjects. Group 2 patients had lower resting anal pressure [p<0.001], squeeze pressure [p=0.02], and higher thresholds of minimal rectal sensation [p<0.001], sense of desire for defaecation [p=0.009] and maximum tolerable volume [p=0.002] than group 1 patients. Group 2b [patients with DAN and microaniopathy] had significantly lower resting anal pressure than group 2a [patients with DAN] [p=0.001]. Anorectal dysfunctions occur in diabetic patients particularly when complicated by autonomic neuropathy and microangiopathy