Anorectal dysfunctions in diabetic autonomic neuropathy and microangiopathy

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. © 2010 Arab Journal of Gastroenterology.