Diabetes Mellitus and the Colon.
Diabetes Mellitus and the Colon.
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DOI：
10.1007/s11938-017-0151-1
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Saad RJ
中科院分区：
文献类型：
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作者：
Piper MS;Saad RJ
糖尿病（DM）可影响结肠的结构和功能，常见的会引发下消化道症状，如便秘、腹泻、腹胀、胃肠胀气和腹痛。糖尿病成人患者风险更高的特定结肠疾病包括慢性便秘、肠道疾病性腹泻、结直肠癌（CRC）、炎症性肠病、显微镜下结肠炎和艰难梭菌结肠炎。平滑肌的结构和功能、卡哈尔间质细胞的密度以及结肠自主神经和肠神经的健康和功能都可能受到糖尿病的影响。这些影响反过来会导致结肠运动、内脏感觉、免疫功能、内皮功能和结肠微生物群的改变。当初始治疗措施对便秘症状无效时，应考虑对慢传输型便秘以及盆底功能障碍进行评估和治疗。在诊断肠道疾病性腹泻之前，应考虑并排除糖尿病相关药物以及小肠疾病，如乳糜泻和小肠细菌过度生长。鉴于结直肠癌的风险较高，糖尿病成人患者应进行适当的筛查，可能需要更长时间的肠道准备以确保充分评估。
Diabetes mellitus (DM) can affect the structure and function of the colon promoting commonly encountered lower gastrointestinal symptoms such as constipation, diarrhea, abdominal distention, bloating, and abdominal pain. Specific colonic disorders for which adults with DM are at greater risk include chronic constipation, enteropathic diarrhea, colorectal cancer (CRC), inflammatory bowel disease, microscopic colitis, and Clostridium difficile colitis. Smooth muscle structure and function, density of the interstitial cells of Cajal, and the health and function of the autonomic and enteric nerves of the colon are all potential affected by DM. These effects can in turn lead to alterations in colon motility, visceral sensation, immune function, endothelial function, and the colonic microbiome. The evaluation and treatment for slow transit constipation as well as pelvic floor dysfunction should be considered when constipation symptoms are refractory to initial treatment measures. DM-related medications and small bowel conditions such as celiac disease and small intestinal bowel overgrowth should be considered and excluded before a diagnosis of enteropathic diarrhea is made. Given the higher risk of CRC, adults with DM should be appropriately screened and may require a longer bowel preparation to ensure an adequate evaluation.