Gastrointestinal (GI) symptoms such as nausea, vomiting, and diarrhea are relatively common in diabetes mellitus. Population-based studies in Australia have shown that esophageal symptoms are also more common in diabetics than in nondiabetic control patients (18). The underlying pathophysiology is presumed to be a neuropathy; there is a progressive axonal atrophy and segmental demyelination of the parasympathetic fibers in the esophagus. The most typical motility abnormality is ineffective peristalsis. In addition, diabetics suffer gastroparesis and delayed gastric emptying, resulting in increased gastroesophageal reflux. Complicating matters, diabetics suffer from sensory neuropathy in the esophagus; electrical stimulation in the esophagus has revealed reduced or absent cortical responses in diabetics studied, implying markedly reduced sensation (19). This correlates with the "silent" acid reflux disease found in diabetics.
Approximately one-third of diabetics have esophageal manometric abnormalities. The most common findings are diminished LES pressures and decreased amplitude of peristaltic waves in the distal esophagus. Other findings seen are multiple simultaneous contractions and multipeaked contractions. Aperistalsis is very rare (20).
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