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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Simple bedside measurements of blood pressure and systolic pressure response to the Valsalva maneuver will confirm a clinical impression of orthostatic hypotension. Careful questioning of the patient usually elicits other symptoms of autonomic nervous system dysfunction, such as impotence, urinary and fecal incontinence, constipation or diarrhea, blurred vision, or sweating changes. Drugs are the most common cause of autonomic dysfunction, and their benefits should be weighed against the severity of the dysfunction. In addition, diabetes mellitus, uremia, amyloidosis, acute intermittent porphyria, myeloma, tabes dorsalis, and alcohol-nutritional problems may produce symptoms of autonomic dysfunction. Thus, patients who present with autonomic features but no history of dysfunction-producing drugs should undergo complete laboratory evaluation. A regimen of tyramine or L-dopa or a diet rich in cheese, processed meats, and wine (a monoamine), coupled with a monoamine oxidase inhibitor have beneficial effects in patients with orthostatic hypotension due to preganglionic autonomic dysfunction. Patients who do not respond to catecholamine precursors have stable, isolated orthostatic hypotension or a polyneuropathy such as that caused by diabetes.
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PMID:Evaluating dysfunction of the autonomic nervous system. 63 67

The existence of specific, age-related changes in gastrointestinal motility with clinical significance is controversial. Beside the more infrequent primary motility disorders, secondary motility disturbances associated with collagen vascular diseases, endocrinopathies, and neuromuscular diseases are prominent in the older and often multimorbid patients. Especially in geriatric patients, motility associated symptoms are undesired side-effects of drug therapy. The pathophysiology, clinical syndromes, and therapeutic principles of motility disorders in the elderly are discussed. The major symptoms of esophageal dysfunction are dysphagia, chest pain, heartburn, and regurgitation. Oropharyngeal dysphagia, mostly caused by cerebrovascular accidents and other neurologic disorders, leads to disturbances in food intake, and is often complicated by broncho-pulmonary infections arising from recurrent aspiration of food or saliva. Gastrointestinal reflux disease and spastic motility disorders of the esophagus are regarded as possible causes of angina-like chest pain after exclusion of cardiac diseases. Motility disturbances of the stomach and small bowel are often related to systemic disease (i.e., diabetes mellitus, chronic intestinal pseudo-obstruction) of drug side-effects. Mental and physical decline, reduced fluid intake, and constipating drugs are the most relevant factors for idiopathic constipation in the elderly. Fecal incontinence means a great psychological strain for older patients and leads to social isolation.
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PMID:[Gastrointestinal motility in the elderly]. 144 9

We measured anorectal sensory and motor function in 11 patients with multiple sclerosis and fecal incontinence, 11 continent patients with multiple sclerosis, 10 diabetics with fecal incontinence, and 12 healthy control subjects. The threshold volume at which patients with multiple sclerosis and fecal incontinence experienced rectal sensation was higher than that in healthy controls (42.7 +/- 6.2 mL vs. 13.3 +/- 2.8 mL; P less than 0.01) and was similar to that in incontinent diabetics (36.5 +/- 5.7 mL). Patients with multiple sclerosis and incontinent diabetics also showed increased thresholds of phasic external sphincter contraction compared with controls (P less than 0.05). Diabetics with incontinence had reduced resting and maximal voluntary anal sphincter pressures compared with controls (P less than 0.05), whereas patients with multiple sclerosis and incontinence showed only decreased maximal voluntary anal sphincter pressures (P less than 0.01 vs. controls and diabetics). Incontinent patients with multiple sclerosis also required smaller volumes of rectal distention to inhibit internal sphincter tone compared with diabetics and controls (P less than 0.01). Decreased maximal voluntary squeeze pressures were less severe in continent patients with multiple sclerosis than in incontinent patients with multiple sclerosis. We conclude that impaired function of the external anal sphincter and decreased volumes of rectal distention to inhibit the internal anal sphincter or both may contribute to fecal incontinence in multiple sclerosis. In addition, increased thresholds of conscious rectal sensation in some incontinent patients with multiple sclerosis and diabetes mellitus may contribute to fecal incontinence by impairing the recognition of impending defecation.
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PMID:Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. 198 43

Idiopathic diarrhea is a common complication of diabetes mellitus. It occurs frequently, but not exclusively, in patients with poorly controlled insulin-dependent diabetes who also have evidence of diabetic peripheral and autonomic neuropathy. Associated steatorrhea is common and does not necessarily imply a concomitant gastrointestinal disease. The diarrhea is often intermittent; it may alternate with periods of normal bowel movements, or with constipation. It is typically painless, and occurs during the day as well as at night and may be associated with fecal incontinence. Multiple pathogenic mechanisms have been implicated, autonomic neuropathy, bacterial overgrowth, and pancreatic exocrine insufficiency being the most important underlying aberrations. However, diabetic diarrhea does not have a uniform and unequivocal pathogenesis. The diagnosis depends on a judicious clinical assessment accompanied by a stepwise laboratory evaluation, which allows the differentiation idiopathic diabetic diarrhea from the many other causes of diarrhea that can occur in diabetic and nondiabetic patients. The management can be difficult but many therapies, including antibiotics to eradicate bacterial overgrowth, as well as antidiarrheal agents, oral and topical clonidine, and somatostatin analogues may be effective in controlling diabetic diarrhea.
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PMID:Diabetic diarrhea. Pathophysiology, diagnosis, and management. 180 18

Faecal incontinence is a frequent manifestation of diabetic enteropathy. The purpose of this study was to determine whether faecal incontinence in diabetes mellitus correlates with manifestations of diabetic autonomic or peripheral neuropathy at other organ sites. In 12 incontinent and 15 continent diabetics stool frequency and stool continence, basal and squeeze anal sphincter pressures, and continence to rectally infused isotonic saline solution (1500 ml) were prospectively evaluated. These data were correlated to quantitative measures of autonomic neuropathy as assessed by heart rate variation and pupillary reflex response to light, and to quantitative measures of peripheral neuropathy as assessed by nerve conduction velocity and sensitivity to vibration. Incontinent diabetics exhibited decreased basal and squeeze anal sphincter pressures, and reduced continence for fluid compared to their continent controls. The degree of incontinence correlated well with the maximal volume of retained rectally infused saline solution, but neither with basal and squeeze anal sphincter pressures, nor with the severity of autonomic or peripheral neuropathy at other organ sites. It is concluded that a generalized dysfunction of the autonomic or peripheral nervous system does not play a major role in the pathogenesis of faecal incontinence in diabetes mellitus. The great overlap of basal and squeeze anal sphincter pressures in incontinent and continent diabetics raise evidence for disturbances of additional extrasphincteric factors as part of the pathomechanism of faecal incontinence in diabetes mellitus.
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PMID:Faecal incontinence in diabetes mellitus: is it correlated to diabetic autonomic or peripheral neuropathy? 285 32

Gastrointestinal symptoms such as vomiting, constipation, diarrhea, and fecal incontinence occur frequently in patients with diabetes mellitus. In a survey of 136 diabetic outpatients, 76% had one or more gastrointestinal symptoms, the commonest symptom being constipation (found in 60%). In many cases these symptoms are thought to be due to abnormal gastrointestinal motility that, in turn, may be a manifestation of diabetic autonomic neuropathy involving the gastrointestinal tract. The pathophysiology of these gastrointestinal symptoms, clarified in recent studies, and the clinical features and treatment of these problems in diabetic patients are reviewed.
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PMID:Disorders of gastrointestinal motility associated with diabetes mellitus. 640 69

We studied 16 patients with diabetes and fecal incontinence. The onset of incontinence coincided with the onset of chronic diarrhea in most patients. Episodes of incontinence occurred when stools were frequent and loose; however, 24-hour stool weights were usually within normal limits. All patients had evidence of autonomic neuropathy, and one third had steatorrhea. Incontinent diabetics had a lower mean basal anal-sphincter pressure than 35 normal subjects (63 +/- 4 vs. 37 +/- 4 mm Hg; P less than 0.001), reflecting abnormal internal-anal-sphincter function. The increment in sphincter pressure with voluntary contraction (external-sphincter function) was not significantly different from normal. Incontinent diabetics also had impaired continence for a solid sphere and for rectally infused saline. In contrast, 14 diabetics without diarrhea or incontinence had normal sphincter pressures and normal results on tests of continence, even though 79 per cent had evidence of autonomic neuropathy and nearly half had steatorrhea. We conclude that incontinence in diabetic patients is related to abnormal internal-anal-sphincter function, and that as a group, diabetics without diarrhea do not have latent defects in continence.
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PMID:Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. 714 65

Twenty-five patients (ages 10 to 79 years; average, 48 years) with fecal incontinence underwent anorectal manometry with a three-balloon system connected to a physiograph. On a basis of manometric criteria showing the presence of rectal sensation, 17 patients underwent biofeedback conditioning. Underlying disorders included irritable bowel syndrome, diabetes mellitus, anal sphincter damage from surgery or disease, and neurogenic anal dysfunction. Twelve of the 17 patients who received biofeedback training had significant improvement in bowel soiling. Follow-up periods ranged from 2 to 38 months (mean, 15 months). There were no significant differences in threshold of rectal sensation, relaxation of the internal anal sphincter, and pre- and postbiofeedback thresholds of external anal sphincter contraction between responders and nonresponders. Minimal criteria for successful treatment appeared to be ability to sense rectal distension, good motivation, and absence of significant psychological dysfunction. Biofeedback conditioning is a simple and effective technique in the treatment of selected patients with fecal incontinence.
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PMID:Biofeedback therapy for fecal incontinence. 725 62

Investigations for candidiasis of the skin and mucous membranes were done in 191 probands over 65 years of age, of whon 187 were occupants of an old people's home and 4 were having in-patient treatment. In the homes being tested Candida infections of the skin and mucous membranes were very numerous (48% and 26% of those investigated) comparable with the epidemics of thrush in premature and newborn units in previous years. Even the localisation of candidiasis was remarkably similar to that in the newborn and infant age groups (Candida mycosis of the external ear and intercrural area, generalised skin candidiasis resembling Leiner's desquamating erythrodermia). The cause of cutaneous candidiasis in old age was in most cases faecal incontinence in chronically bedridden obese patients (intestinal colonisation with C. albicans). Diabetes mellitus, on the other hand, seems to play only a secondary role in the conditions of old people's homes.
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PMID:[Candida infections in geriatrics-a current problem (author's transl)]. 746 Jul 84

The elucidation of the pathogenesis of faecal incontinence in patients with advanced diabetes mellitus has progressed during the last 15 years. In contrast to earlier concepts which promoted the concept that high stool volumes overwhelm normal continence mechanisms, recent studies indicate that the vast majority of diabetic patients with faecal incontinence have normal or only moderately increased daily stool volumes, but also exhibit multiple abnormalities of anorectal sensory and motor functions. These changes are not observed in continent diabetic patients. Treatment consists of pharmacologic and dietary interventions to modulate diarrhoea, and biofeedback techniques to improve rectal sensory thresholds and striated muscle responsiveness of continence mechanisms. This dual approach is often successful and is free of risks.
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PMID:Incontinence and anorectal dysfunction in patients with diabetes mellitus. 749 60


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