糖尿病患相關的腸胃道併發症

Gastrointestinal Complications of Diabetes

賴瑩純(Ying-Chuen Lai) ； 莊立民(Lee-Ming Chuang)

《內科學誌》 20卷5期 (2009/10) Pp. 409-416

https://doi.org/10.6314/JIMT.2009.20(5).04

摘要

糖尿病患有較高的比率有腸胃道症狀，發生的原因主要爲高血糖引起的自主神經病變造成腸胃蠕動異常(dysmotility)，也可能是合併其它腸胃道疾病或藥物引起，且在腸胃道任何區域都可能發生問題，常見的腸胃道併發症，在食道爲胃食道逆流，及食道念珠菌感染，在胃，爲胃輕癱(gastroparesis)；在小腸爲腹瀉、腸道細菌增生、及麩質過敏症(celiac disease)，在大腸肛門爲便祕、及肛門括約肌無力。胃食道逆流、及食道念珠菌感染診斷並不難，治療也與一般情況相同。糖尿病胃輕癱的診斷要排除機械性阻塞(mechanic obstruction)及其它原因，加上在核醫影像上顯示胃排空時間延長，依病情嚴重度，對於輕中度患者控制血糖、飲食調整、胃腸蠕動促進劑(prokinetic agents)就有效果，嚴重患者考慮胃電刺激方式(gastric electrical stimulation)、甚至手術胃造口及腸造口以進行管灌飲食。糖尿病腹瀉、便祕及肛門括約肌無力也是靠排除其它原因而診斷，除了血糖控制，治療上仍以支持性及症狀治療爲主，若有懷疑麩質過敏症(celiac diseae)，建議無麩質飲食。找出高血糖與腸道神經病變的機轉，及回復神經功能是未來治療上的一大課題。

關鍵字

糖尿病 ； 自主神經病變 ； 胃輕癱 ； 便祕 ； 腹瀉

並列摘要

Diabetic patients have higher prevalence of gastrointestinal symptoms. The main cause is gastrointestinal dysmotility associated with enteric autonomic neuropathy. Other gastrointestinal diseases or medications are also among the causes. Common gastrointestinal complications of diabetes include acid reflux, dysmotility, and Candida esophagitis in esophagus; gastroparesis in stomach; diarrhea, bacterial overgrowth, and celiac disease in intestine; constipation in colon; fecal incontinence in anus. Diagnosis of esophageal complication is not difficult. The treatment is the same as those for other common conditions. Diabetic gastroparesis is a diagnosis by exclusion and a delayed gastric emptying time on scintiscan. Patients with mild to moderate symptoms are often successfully treated with glycemic control, diet adjustment, and prokinetic agents. For severe disease, gastric electrical stimulation, gastrostomy for decompression and jejunostomy for feeding are other choices. Diabetic diarrhea, constipation, and fecal incontinence are also diagnosed by exclusion. In addition to glycemic control, the therapy is basically supportive and symptomatic. If celiac disease is suspected, gluten free diet is suggested. In the future, studies that focus the mechanism of glycemia induced neuron apoptosis and of reversal of the nerve function are warranted.

並列關鍵字

Diabetes mellitus ； DM ； Autonomic neuropathy ； Gastroparesis ； Constipation ； Diarrhea