Summary
The digestive tract has been examined by light microscopy in 17 subjects with diabetes of early onset, long duration and with various causes of death, in 6 “normal” controls and 10 controls with uremia and/ or hypertension. In the diabetics grave lesions were demonstrated to a large extent in the capillaries and venules of the oral mucosa, and in small arteries and arterioles in the gastroïntestinal tract (from the oesophagus to rectum). The capillary and venular lesions were similar to those earlier described in the skin of diabetics. The arterial lesion was characterized by a hyalin, strongly PAS-positive, picrinophilic (eosinophilic), richly fat-containing (sudanophilic) wall thickening accompanied by heavy reduction of the lumen, endothelial atrophy and medial degeneration. Similar arterial lesions were demonstrated in the kidneys, pancreas, liver, spleen, adrenal glands, testes, prostate and ovaries. The study suggests that hypertension was not of essential importance to the development of the arterial lesions. It is assumed that the grave arterial lesion accentuates terminally in the course of diabetes, where final complications such as ischemia and adrenocortical overactivity are of pathogenetic significance.
Résumé
On a examiné au microscope optique l'appareil digestif de 17 sujets atteints de diabète précoce, de longue durée et dont la mort était due à différentes causes, de 6 sujets de contrôle ≪normaux≫ et de 10 autres patients atteints d'urémie et/ou d'hypertension. Chez les diabétiques on a trouvé, dans une grande mesure, de graves lésions localisées dans les capillaires et les veinules de la muqueuse buccale, et dans les petites artères et artérioles de l'appareil gastro-intestinal (de l'oesophage au rectum). Les lésions des capillaires et des veinules étaient semblables à celles précédemment décrites dans la peau des diabétiques. La lésion artérielle était caractérisée par un épaissement de la paroi, hyalin, fortement PAS-positif, picrinophile (éosinophile), contenant beaucoup de graisse (soudanophile), accompagné d'une forte réduction de la lumière, d'une atrophie endothéliale, et d'une dégénérescence de la média. Des lésions artérielles semblables ont été trouvées dans les reins, le pancréas, le foie, la rate, les glandes surrénales, les testicules, la prostate et les ovaires. Cette étude suggère que l'hypertension n'était pas d'importance essentielle pour le développement des lésions artérielles. On admet que la lésion artérielle grave s'accentue vers le stade final du diabète, où des complications finales, telles que l'ischémie et la suractivité adrénocorticale, sont d'importance pathogénique.
Zusammenfassung
Bei 17 Patienten mit frühmanifestem Langzeit-Diabetes mit verschiedener Todesursache bei 6 „normalen“ Kontrollpersonen und 10 Kontrollpersonen mit Uraemie und/oder Bluthochdruck wurde der Verdauungstrakt lichtmikroskopisch untersucht. Bei den Diabetikern wurden an den Kapillaren und Venolen der Mundschleimhaut in großer Ausdehnung schwere Veränderungen gefunden, ebenso in den kleinen Arterien und Arteriolen des Verdauungstraktes (vom Oesophagus bis zum Rectum). Die Veränderungen an den Kapillaren und Venolen waren ähnlich wie die schon früher in der Haut von Diabetikern beschriebenen. Der arterielle Schaden war durch eine hyaline, stark PAS-positive, picrinophile (eosinophile), reichlich fettenthaltende (sudanophile) Wandverdickung charakterisiert, die mit einer starken Einengung des Lumens, Endothelatrophie und Mediadegeneration einherging. Ähnliche arterielle Veränderungen wurden an den Nieren, an Pankreas, Leber, Milz, Nebennieren, Testes, Prostata und Ovarien nachgewiesen. Die Untersuchung läßt vermuten, daß der Bluthochdruck für die Entwicklung der arteriellen Schäden nicht von wesentlicher Bedeutung war. Es wird angenommen, daß die schweren arteriellen Veränderungen im Endstadium des Diabetes besonders ausgeprägt werden, wo Spätkomplikationen wie Durchblutungsstörungen und Überaktivität der Nebenniere von pathogenetischer Bedeutung sind.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Aagenaes, Ø., and H. Moe: Light-and electronmicroscopic study of skin capillaries of diabetics. Diabetes 10, 253–259 (1961).
Alex, M., E.K. Baron, S. Goldenberg and H.T. Blumenthal: An autopsy study of cerebrovascular accident in diabetes mellitus. Circulation 25, 663–673 (1962).
Angervall, L., G. Dotevall and K.-E. Lehmann: The gastric mucosa in diabetes mellitus. A functional and histopathological study. Acta med. scand. 169, 339–349 (1961).
— and H. Tillander: Amelioration of diabetes mellitus following gastric resection. Acta med. scand. 160, 743–748 (1961).
— and K.-E. Lehmann: Gastric mucosa in patients with diabetes of early onset. Acta path. microbiol. scand. suppl. 154, 108–110 (1962).
—, and S.-E. Fagerberg: Skin biopsy in diabetes. Acta path. microbiol. scand. 58, 391–392 (1963).
—, and B. Stener: Tumoriform focal muscular degeneration in two diabetic patients. Diabetologia 1, 39–42 (1965).
—, and J. Säve-Söderbergh: Diabetisk mikroangiopatii digestionskanalen. Nord. Med. 73, 523 (1965).
Bencosme, S.A., R.O. West, J.W. Kerr and D.L. Wilson: Diabetic capillary angiopathy in human skeletal muscless. Amer. J. Med. 40, 67–77 (1966).
Banson, B.B., and P.E. Lacy: Diabetic microangiopathy in human toes. With emphasis on the ultrastructural change in dermal capillaries. Amer. J. Path. 45, 41–58 (1964).
Bloodworth, J.M.B., Jr., and G.J. Hamwi: Experimental diabetic glomerulosclerosis. Diabetes 5, 37–43 (1956).
—: Diabetic microangiopathy. Diabetes 12, 99–114 (1963).
Blumenthal, H.T., M. Alex and S. Goldenberg: A study of lesions of the intramural coronary artery branches in diabetes mellitus. A.M.A. Arch. Path. 70, 13–28 (1960).
Bojsen-Møller, F., P. Grønbaek and J. Rostgaard: Light microscopic study of gastrointestinal and skin capillaries in diabetes mellitus. Diabetes 12, 429–432 (1963).
Burstein, R., S.D. Soule and H.T. Blumenthal: Histogenesis of the pathological processes in placentas of metabolic disease in pregnancy. II. The diabetic state. Amer. J. Obstet. Gynec. 74, 96–104 (1957).
Dagnini, G., and E. Moreschi: L'arteriolopatia del fegato nel diabete mellito. G. Clin. Med. 40, 867–885 (1959).
Dustin, P., Jr.: Arteriolar hyalinosis. In: International rewiew of experimental pathology. New York. Academie Press, pp. 73–138, 1962.
Fagerberg, S.-E.: Diabetic neuropathy; a clinicl and histological study on the significance of vascular affections. Acta med. scand. suppl. 345, 1–97 (1959).
Fuchs, U.: Elektronenmikroskopische Untersuchungen menschlicher Muskelcapillaren bei Diabetes mellitus. Frankfurt. Z. Path. 73, 318–328 (1964).
Funk, H.U.: Veränderungen an kleinen Extremitätengefßßen von Diabetikern. Schweiz, med. Wschr. 95, 487–492 (1965).
Goldenberg, S., M. Alex, R.A. Joshi and H.T. Blu-Menthal: Nonatheromatus peripheral vascular disease of the lower extremity in diabetes mellitus. Diabetes 8, 261–273 (1959).
Handelsman, M.B., T.G. Morrione and B. Ghitman: Skin vascular alterations in diabetes mellitus. Arch. intern. Med. 110, 70–77 (1962).
Holle, G.: Über elektronenmikroskopische Befunde bei diabetischer Angiopathie. Arch. klin. Chir. 295, 253–258 (1960).
Kimmelstiel, P., and C. Wilson: Intercapillary lesions in the glomeruli of the kidney. Amer. J. Path. 12, 83–98 (1936).
Lazarus, S.S., and B.W. Volk: Pancreas in maturity-onset diabetes. A.M.A. Arch. Path. 71, 44–59 (1961).
LeCompte, P.: Glomerular lesions in diabetes: Light microscopy and histochemistry. In Siperstein, M.D., Colwell, A.R., Sr., and K Mayer (editors): Small blood vessel involvement in diabetes mellitus. Washington, D.C., American Institute of Biological Sciences, pp 1–6 and p. 289, 1964.
Lentle, B.C., and J.P. Thomas: Adrenal function and the complications of diabetes mellitus. Lancet 1964 II, 544–549.
Moore, J.M., and I.D.O. Frew: Peripheral vascular lesions in diabetes mellitus. Brit. med. J. 1965 II, 19–23.
Muirhead, E.E., P.O'B. Montgomery and E. Booth: The glomerular lesions of diabetes mellitus. Arch. intern. Med. 98, 146–161 (1956).
Ogilvie, R.R., M.S. Sabour and N.W. Horne: Light and electronmicroscopy of prednisolone-induced nephropathy in rabbits. Diabetes 14, 595–605 (1965).
Pedersen, J., and S. Olsen: Small-vessel disease of the lower extremity in diabetes mellitus. On the pathogenesis of the foot-lesions in diabetics. Acta med. scand. 171, 551–559 (1962).
Pieri, A., P.T. Scarpelli and M. Rizzo: Small blood vessel involvement in diabetes mellitus: Light microscope study of specimens obtained by ear lobe biopsy. Diabetologia 1, 109–115 (1965).
Rich, A.R., M. Berthrong and I.L. Bennet Jr.: The effect of cortisone upon the experimental cardiovascular and renal lesions produced by anaphylactic hypersensitivity. Bull. Johns Hopk. Hosp. suppl, 87, 549–567 (1950).
Säve-Söderbergh, J., L. Angervall, S. Eneström and S.-E. Fagerberg: Morphology and pathogenesis of dermal microangiopathy in young diabetic men. Acta path. microbiol. scand. 66, 274 (1966).
Weber, H.W., and C.L. Wicht: The peripheral angiopathy of diabetics. A plethysmographic and histopathological study. S. Afr. J. Lab. clin. Med. 8, 83–93 (1962).
Woltman, H.W., and R.M. Wilder: Diabetes mellitus; nathologic changes in spinal cord and peripheral nerves. Arch. intern. Med. 44, 576–603 (1962).
Zacks, S.I., J.J. Pegues and F.A. Elliot: Interstitial muscle capillaries in patients with diabetes mellitus: A light and electronmicroscope study. Metabolism 11, 381–393 (1962).
Zschoch, H.: Arterielle Gefäßveränderungen in der Leber unter besonderer Berücksichtigung des Diabetes mellitus. Verchows Arch. path. Anat. 336, 291–297 (1963).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Angervall, L., Säve-Söderbergh, J. Microangiopathy in the digestive tract in subjects with diabetes of early onset and long duration. Diabetologia 2, 117–122 (1966). https://doi.org/10.1007/BF00423020
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00423020