Skip to main content
SpringerLink
Log in

Gastrointestinal and Urinary Dysfunction

  • Chapter
  • First Online:
Diabetic Neuropathy and Clinical Practice

  • 643 Accesses

Abstract

Gastrointestinal (GI) autonomic neuropathy like other autonomic neuropathies by common consensus is also grossly underdiagnosed in diabetes. Nonspecific symptomatology and delayed clinical appreciation, if at all, of the same are the most important factors. The diagnostics available is sparse, costly, and not always without some variation in its undertaking. As a result, no satisfactory explanation of symptoms is given by the physician. That is likely to result in unfocused haphazard investigation and drug treatment, which resolves neither the issue nor the diagnostic dilemma disrupting the quality of life of a patient.

Autonomic Urinary Dysfunction with or without diabetes, especially urinary bladder atony without prostatic obstruction, is seen in the practice of urology more frequently. Urinary stasis in diabetes is the harbinger of many serious issues.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Even otherwise, standing abdomen X-ray is a test vanishing from clinical practice in India like many other simple investigations. Aside of perforation in stomach or gastroparesis, subacute or acute obstruction is so easily diagnosable. Subacute variety can be seen in diabetes and making a sound diagnosis taking a total clinical situation in account. It can save a lot of inconvenience, money, make a quick, correct diagnosis and achieve ease of treatment.

  2. 2.

    Total Parenteral Nutrition used extensively in critical medicine is much less used in indoor care. This topic is extensively discussed to help clinicians undertake this modality in the author’s volume on “Towards Optimal Management of Diabetes in Surgery,” also published by Springer in August 2019. The discussion will be found in the chapter on commonly asked questions.

  3. 3.

    The huge response that an Indian motion picture entirely based on the constipation neurosis, “PICU,” received is an indicator of how dear the issue is to Indian patient.

References

  1. Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med. 1980;49:95–108. PMID: 7433630.

    CAS  PubMed  Google Scholar 

  2. Maser RE, Pfeifer MA, Dorman JS, Kuller LH, Becker DJ, Orchard TJ. Diabetic autonomic neuropathy and cardiovascular risk. Pittsburgh Epidemiology of Diabetes Complications Study III. Arch Intern Med. 1990;150:1218–22. PMID: 2353855.

    Article  CAS  PubMed  Google Scholar 

  3. Trotta D, Verrotti A, Salladini C, Chiarelli F. Diabetic neuropathy in children and adolescents. Pediatr Diabetes. 2004;5:44–57. https://doi.org/10.1111/j.1399-543x.2004.00041.x. PMID: 15043690.

    Article  PubMed  Google Scholar 

  4. Koch KL. Diabetic gastropathy: gastric neuromuscular dysfunction in diabetes mellitus: a review of symptoms, pathophysiology, and treatment. Dig Dis Sci. 1999;44:1061–75.

    Article  CAS  PubMed  Google Scholar 

  5. Parkman HP, Camilleri M, Farrugia G, et al. Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting. Neurogastroenterol Motil. 2010;22:113–33.

    Article  CAS  PubMed  Google Scholar 

  6. Stanghellini V, Tosetti C, Paternico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology. 1996;110:1036–42.

    Article  CAS  PubMed  Google Scholar 

  7. Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–404.

    Article  CAS  PubMed  Google Scholar 

  8. Chandrasekharan B, Srinivasan S. Diabetes and the enteric nervous system. Neurogastroenteral Motil. 2007;19:951–60. https://doi.org/10.1111/j.1365-2982.2007.01023.x.

    Article  CAS  Google Scholar 

  9. Furness JB, Kunze WA, Bertrand PP, Clerc N, Bornstein JC. Intrinsic primary afferent neurons of the intestine. Prog Neurobiol. 1998;54(1):1–18.

    Article  CAS  PubMed  Google Scholar 

  10. Jänig W. Integration of gut function by sympathetic reflexes. Baillieres Clin Gastroenterol. 1988;2(1):45–62.

    Article  PubMed  Google Scholar 

  11. Farrugia G. Interstitial cells of Cajal in health and disease. Neurogastroenterol Motil. 2008;20(Supplement 1):54–63.

    Article  PubMed  Google Scholar 

  12. Blackshaw LA, Gebhart GF. The pharmacology of gastrointestinal nociceptive pathways. Curr Opin Pharmacol. 2002;2(6):642–9.

    Article  CAS  PubMed  Google Scholar 

  13. Sawchenko PE. Central connections of the sensory and motor nuclei of the Vagus nerve. J Auton Nerv Syst. 1983;9(1):13–26.

    Article  CAS  PubMed  Google Scholar 

  14. Bagyánszki M, Bódi N. Diabetes-related alterations in the enteric nervous system and its microenvironment. World J Diabetes. 2012;3(5):80–93.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bódi N, Talapka P, Poles MZ, et al. Gut region-specific diabetic damage to the capillary endothelium adjacent to the myenteric plexus. Microcirculation. 2012;19(4):316–26.

    Article  PubMed  CAS  Google Scholar 

  16. Tahara T, Yamamoto T. Morphological changes of the villous microvascular architecture and intestinal growth in rats with streptozotocin-induced diabetes. Virchows Arch A Pathol Anat Histopathol. 1988;413(2):151–8.

    Article  CAS  PubMed  Google Scholar 

  17. Tomlinson DR, Gardiner NJ. Glucose neurotoxicity. Nat Rev Neurosci. 2008;9(1):36–45.

    Article  CAS  PubMed  Google Scholar 

  18. Semra YK, Wang M, Peat NJ, Smith NCE, Shotton HR, Lincoln J. Selective susceptibility of different populations of sympathetic neurons to diabetic neuropathy in vivo is reflected by increased vulnerability to oxidative stress in vitro. Neurosci Lett. 2006;407(3):199–204.

    Article  CAS  PubMed  Google Scholar 

  19. Chandrasekharan B, Anitha M, Blatt R, et al. Colonic motor dysfunction in human diabetes is associated with enteric neuronal loss and increased oxidative stress. Neurogastroenterol Motil. 2011;23(2):131–e26.

    Article  CAS  PubMed  Google Scholar 

  20. Choi KM, Gibbons SJ, Nguyen TV, et al. Heme oxygenase-1 protects interstitial cells of Cajal from oxidative stress and reverses diabetic gastroparesis. Gastroenterology. 2008;135(6):2055–2064.e2.

    Article  CAS  PubMed  Google Scholar 

  21. Iwasaki H, Kajimura M, Osawa S, et al. A deficiency of gastric interstitial cells of Cajal accompanied by decreased expression of neuronal nitric oxide synthase and substance P in patients with type 2 diabetes mellitus. J Gastroenterol. 2006;41(11):1076–87.

    Article  CAS  PubMed  Google Scholar 

  22. Horváth VJ, Vittal H, Lörincz A, et al. Reduced stem cell factor links smooth myopathy and loss of interstitial cells of Cajal in murine diabetic gastroparesis. Gastroenterology. 2006;130(3):759–70.

    Article  PubMed  CAS  Google Scholar 

  23. Ochoa-Cortes F, Turco F, Linan-Rico A, et al. Enteric glial cells: a new frontier in neurogastroenterology and clinical target for inflammatory bowel diseases. Inflamm Bowel Dis. 2016;22(2):433–49.

    Article  PubMed  Google Scholar 

  24. De Block CE, De Leeuw IH, Pelckmans PA, et al. Delayed gastric emptying and gastric autoimmunity in type 1 diabetes. Diabetes Care. 2002;25:912–7.

    Article  PubMed  Google Scholar 

  25. Goo RH, Moore JG, Greenberg E, et al. Circadian variation in gastric emptying of meals in humans. Gastroenterology. 1987;93:515–8.

    Article  CAS  PubMed  Google Scholar 

  26. Krishnasamy S, Abell TL. Diabetic gastroparesis: principles and current trends in management. Diabetes Ther. 2018;9(Suppl 1):S1–S42. https://doi.org/10.1007/s13300-018-0454-9.

    Article  CAS  Google Scholar 

  27. Hyett B, Martinez FJ, Gill BM, et al. Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis. Gastroenterology. 2009;137:445–52.

    Article  PubMed  Google Scholar 

  28. Kedar A, Nikitina Y, Henry OR, et al. Gastric dysmotility and low serum vitamin D levels in patients with gastroparesis. Horm Metab Res. 2013;45:47–53.

    CAS  PubMed  Google Scholar 

  29. Chang J, Rayner CK, Jones KL, Horowitz M. Diabetic gastroparesis-backwards and forwards. J Gastroenterol Hepatol. 2011;26(Suppl1):46–57. https://doi.org/10.1111/j.1440-1746.2010.06573.x.

    Article  PubMed  Google Scholar 

  30. Horváth VJ, Izbéki F, Lengyel C, Kempler P, Várkonyi T. Diabetic gastroparesis: functional/morphologic background, diagnosis, and treatment options. Curr Diab Rep. 2014;14:527. https://doi.org/10.1007/s11892-014-0527-8. PMID: 25005121.

    Article  CAS  PubMed  Google Scholar 

  31. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–63. https://doi.org/10.1111/j.1572-0241.2007.01636.x. PMID: 18028513.

    Article  PubMed  Google Scholar 

  32. Chang CS, Chen GH, Kao CH, Wang SJ, Peng SN, Poon SK, Huang CK. Gastric clearance of radio opaque markers in non-ulcer dyspepsia patients. Scand J Gastroenterol. 1996;31:136–9. https://doi.org/10.3109/00365529609031977. PMID: 8658035.

    Article  CAS  PubMed  Google Scholar 

  33. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–622. https://doi.org/10.1053/j.gastro.2004.09.055. PMID: 15521026.

    Article  PubMed  Google Scholar 

  34. Farmer AD, Scott SM, Hobson AR. Gastrointestinal motility revisited: the wireless motility capsule. United European Gastroenterol J. 2013;1:413–21. https://doi.org/10.1177/2050640613510161. PMID: 24917991.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lee YY, Erdogan A, Rao SS. How to assess regional and whole gut transit time with wireless motility capsule. J Neurogastroenterol Motil. 2014;20:265–70. https://doi.org/10.5056/jnm.2014.20.2.265. PMID: 24840380.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Tran K, Brun R, Kuo B. Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice. Ther Adv Gastroenterol. 2012;5:249–60. https://doi.org/10.1177/1756283x12437874. PMID: 22778790.

    Article  Google Scholar 

  37. Cassilly D, Kantor S, Knight LC, Maurer AH, Fisher RS, Semler J, Parkman HP. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20:311–9. https://doi.org/10.1111/j.1365-2982.2007.01061.x. PMID: 18194154.

    Article  CAS  PubMed  Google Scholar 

  38. Rouphael C, Arora Z, Thota PN, et al. Role of wireless motility capsule in the assessment and management of gastrointestinal dysmotility in patients with diabetes mellitus. Neurogastroenterol Motil. 2017;29(9) https://doi.org/10.1111/nmo.13087.

    Article  CAS  Google Scholar 

  39. Farmer AD, Pedersen AG, Brock B, et al. Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered cecal pH profile. Diabetologia. 2017;60(4):709–18.

    Article  PubMed  Google Scholar 

  40. Sarosiek I, Selover KH, Katzetal LA. Clinical trial: assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology. Aliment Pharmacol Ther. 2009;31(2):313–22.

    PubMed  PubMed Central  Google Scholar 

  41. Coleski R, Wilding GE, Semler JR, Hasler WL. Blunting of colon contractions in diabetics with gastroparesis quantified by wireless motility capsule methods. PLoS One. 2015;10(10):e0141183.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Ohlsson B, Melander O, Thorsson O, Olsson R, Ekberg O, Sundkvist G. Esophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis. Diabetologia. 2006;49(9):2010–4.

    Article  CAS  PubMed  Google Scholar 

  43. Boronikolos GC, Menge BA, Schenker N, et al. Upper gastrointestinal motility and symptoms in individuals with diabetes, pre-diabetes and normal glucose tolerance. Diabetologia. 2015;58(6):1175–82.

    Article  CAS  PubMed  Google Scholar 

  44. Snape WJ Jr, Matarazzo SA, Cohen S. Effect of eating and gastrointestinal hormones on human colonic myoelectrical and motor activity. Gastroenterology. 1978;75(3):373–8.

    Article  CAS  PubMed  Google Scholar 

  45. Dinning PG. A new understanding of the physiology and pathophysiology of colonic motility? Neurogastroenterol Motile. 2018;30:e13395.

    Article  CAS  Google Scholar 

  46. Parkin CG, Homberg A, Hinzmann R. 10th Annual Symposium on Self-Monitoring of Blood Glucose, April 27–29, 2017, Warsaw, Poland. Diabetes Technol Ther. 2018;20(1):68–89.

    Article  PubMed  PubMed Central  Google Scholar 

  47. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes–2018. Diabetes Care. 2017;41(Supplement 1):S55–64.

    Article  Google Scholar 

  48. Borot S, Benhamou PY, Atlan C, et al. Practical implementation, education and interpretation guidelines for continuous glucose monitoring: a French position statement. Diabetes Metab. 2018;44(1):61–72.

    Article  CAS  PubMed  Google Scholar 

  49. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631–40.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Dyck PJ, Thomas PK. Diabetic neuropathy. 2nd ed. Philadelphia: W B Saunders; 1999. p. 211–2.

    Google Scholar 

  51. Gustafsson RJ, Littorin B, Berntorp K, et al. Esophageal dysmotility is more common than gastroparesis in diabetes mellitus and is associated with retinopathy. Rev Diabet Stud. 2011;8(2):268–75.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kinekawa F, Kubo F, Matsuda K, Fujita Y, Tomita T, Uchida Y, Nishioka M. Relationship between esophageal dysfunction and neuropathy in diabetic patients. Am J Gastroenterol. 2001;96:2026–32. https://doi.org/10.1111/j.1572-0241.2001.03862.x. PMID: 11467628.

    Article  CAS  PubMed  Google Scholar 

  53. Annese V, Bassotti G, Caruso N, De Cosmo S, Gabbrielli A, Modoni S, Frusciante V, Andriulli A. Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus. J Clin Gastroenterol. 1999;29:171–7. PMID: 10478880.

    Article  CAS  PubMed  Google Scholar 

  54. Lluch I, Ascaso JF, Mora F, Minguez M, Peña A, Hernandez A, Benages A. Gastroesophageal reflux in diabetes mellitus. Am J Gastroenterol. 1999;94:919–24. https://doi.org/10.1111/j.1572-0241.1999.987_j.x. PMID: 10201457.

    Article  CAS  PubMed  Google Scholar 

  55. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943. PMID: 16928254. https://doi.org/10.1111/j.1572-0241.2006.00630.x.

    Article  PubMed  Google Scholar 

  56. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7. https://doi.org/10.1136/gut.2004.051821. PMID: 15831922.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet. 2006;367:2086–100. https://doi.org/10.1016/S0140-6736(06)68932-0. PMID: 16798392.

    Article  PubMed  Google Scholar 

  58. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354:2340–8. https://doi.org/10.1056/NEJMoa054391. PMID: 16738270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Zheng Z, Margolis KL, Liu S, Tinker LF, Ye W, Investigators W’s HI. Effects of estrogen with and without progestin and obesity on symptomatic gastro-esophageal reflux. Gastroenterology. 2008;135:72–81. https://doi.org/10.1053/j.gastro.2008.03.039. PMID: 18502208.

    Article  PubMed  Google Scholar 

  60. El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR. Obesity increases oesophageal acid exposure. Gut. 2007;56:749–55. https://doi.org/10.1136/gut.2006.100263. PMID: 17127706.

    Article  PubMed  Google Scholar 

  61. Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is also associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9. https://doi.org/10.1053/j.gastro.2006.12.032. PMID: 17324403.

    Article  PubMed  Google Scholar 

  62. Iwakiri K, Sugiura T, Hayashi Y, Kotoyori M, Kawakami A, Makino H, Nomura T, Miyashita M, Takubo K, Sakamoto C. Esophageal motility in Japanese patients with Barrett’s esophagus. J Gastroenterol. 2003;38:1036–41. https://doi.org/10.1007/s00535-003-1193-9. PMID: 14673719.

    Article  PubMed  Google Scholar 

  63. Johnson DA, Fennerty MB. Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology. 2004;126:660–4. PMID: 14988819.

    Article  PubMed  Google Scholar 

  64. Mohammed I, Cherkas LF, Riley SA, Spector TD, Trudgill NJ. Genetic influences in gastro-oesophageal reflux disease: a twin study. Gut. 2003;52:1085–9. PMID: 12865263.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Frøkjaer JB, Andersen SD, Ejskaer N, Funch-Jensen P, Arendt Nielsen L, Gregersen H, Drewes AM. Gut sensations in diabetic autonomic neuropathy. Pain. 2007;131:320–9. https://doi.org/10.1016/j.pain.2007.04.009. PMID: 17521809.

    Article  PubMed  Google Scholar 

  66. Dettmar PW, Sykes J, Little SL, Bryan J. Rapid onset of effect of sodium alginate on gastro-oesophageal reflux compared with ranitidine and omeprazole, and relationship between symptoms and reflux episodes. Int J Clin Pract. 2006;60:275–83. https://doi.org/10.1111/j.1368-5031.2006.00800.x.

    Article  CAS  PubMed  Google Scholar 

  67. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med. 2001;161(16):1989–96.

    Article  CAS  PubMed  Google Scholar 

  68. Ko GTC, Chan WB, Chan JCN, Tsang LWW, Cockram CS. Gastrointestinal symptoms in Chinese patients with type 2 diabetes mellitus. Diabet Med. 1999;16(8):670–4.

    Article  CAS  PubMed  Google Scholar 

  69. Wang YR, Fisher RS, Parkman HP. Gastroparesis related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol. 2008;103(2):313–22.

    Article  PubMed  Google Scholar 

  70. Horowitz M, Harding PE, Maddox AF, et al. Gastric and esophageal emptying in patients with type 2 (non-insulin dependent) diabetes mellitus. Diabetologia. 1989;32(3):151–9.

    Article  CAS  PubMed  Google Scholar 

  71. Rayner CK, Verhagen MAMT, Hebbard GS, DiMatteo AC, Doran SM, Horowitz M. Proximal gastric compliance and perception of distension in type 1 diabetes mellitus: effects of hyperglycemia. Am J Gastroenterol. 2000;95(5):1175–83.

    Article  CAS  PubMed  Google Scholar 

  72. Enck P, Rathmann W, Spiekermann M, et al. Prevalence of gastrointestinal symptoms in diabetic patients and nondiabetic subjects. Z Gastroenterol. 1994;32(11):637–41.

    CAS  PubMed  Google Scholar 

  73. Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18(1):141–50.

    Article  CAS  PubMed  Google Scholar 

  74. Camilleri M. Novel diet, drugs, and gastric interventions for gastroparesis. Clin Gastroenterol Hepatol. 2016;14(8):1072–80.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Janssen P, Scott Harris M, Jones M, et al. The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis. Am J Gastroenterol. 2013;108(9):1382–91.

    Article  CAS  PubMed  Google Scholar 

  76. Patterson D, Abell T, Rothstein R, Koch K, Barnett J. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol. 1999;94(5):1230–4.

    CAS  PubMed  Google Scholar 

  77. Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. N Engl J Med. 1990;322(15):1028–31.

    Article  CAS  PubMed  Google Scholar 

  78. Hasler WL. Emerging drugs for the treatment of gastroparesis. Expert Opin Emerg Drugs. 2014;19:261–79.

    Article  CAS  PubMed  Google Scholar 

  79. Törnblom H. Treatment of gastrointestinal autonomic neuropathy. Diabetologia. 2016;59(3):409–13.

    Article  PubMed  CAS  Google Scholar 

  80. Lavö B, Stenstam M, Nielsen AL. Loperamide in treatment of irritable bowel syndrome—a double-blind placebo controlled study. Scand J Gastroenterol. 1987;130:77–80.

    Article  Google Scholar 

  81. Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut. 2011;60(2):209–18.

    Article  PubMed  Google Scholar 

  82. Drewes AM, Munkholm P, Simrén M, et al. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-recommendations of the Nordic Working Group. Scand J Pain. 2016;11(1):111–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Independent Health Researcher, Pune, Maharashtra, India

    Sanjeev Kelkar

Authors
  1. Sanjeev Kelkar
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kelkar, S. (2020). Gastrointestinal and Urinary Dysfunction. In: Diabetic Neuropathy and Clinical Practice. Springer, Singapore. https://doi.org/10.1007/978-981-15-2417-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-2417-2_5

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-2416-5

  • Online ISBN: 978-981-15-2417-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation