Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

Abstract 

Background and study aims

Disturbed motility may explain gastrointestinal symptoms of patients with diabetic neuropathy. This study investigates the anorectal dysfunctions in diabetic autonomic neuropathy (DAN) and microangiopathy.

Patients and methods

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.

Results

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).

Conclusion

Anorectal dysfunctions occur in diabetic patients particularly when complicated by autonomic neuropathy and microangiopathy.

Keywords: Diabetic neuropathy, Microangiopathy, Anorectal manometry