Gastrointestinal and Hepatic Manifestations of Systemic Diseases

  • Ellen C. Ebert


Gastrointestinal (GI) presentations are common manifestations of systemic disease. Diabetics manifest delayed gastric emptying, poorly correlated with symptoms and linked to poor glycemic control. Treatment with metoclopramide and domperidone for antiemesis may cause central nervous system side effects. Diarrhea, constipation, and small intestinal bacterial overgrowth are recognized to occur in diabetics. Amyloid deposition in the small bowel may present with diarrhea, steatorrhea, or pain. Liver disease, although common, usually has few symptoms but may present with hepatomegaly and a raised alkaline phosphatase. The GI manifestations of thyroid disease range from hypomotility in hypothyroidism to hypermotility in hyperthyroidism, and associated autoimmune gastritis. Sarcoidosis commonly involves the liver; elevated alkaline phosphatase levels are associated with disease ranging from granulomas to biliary cirrhosis. The esophagus is commonly affected in scleroderma with heartburn, dysphagia, and regurgitation. Delayed gastric emptying, small bowel dysmotility with bacterial overgrowth, colonic inertia, and weakness of the internal anal sphincter with fecal incontinence are common in scleroderma. Chronic heart disease may cause congestive hepatopathy, hypoxic hepatitis, malabsorption, and protein-losing enteropathy. Chronic kidney disease is associated with GI bleeding, hypergastrinemia, constipation, pancreatic abnormalities, and nonocclusive mesenteric ischemia.


Chronic Kidney Disease Celiac Disease Gastric Emptying Constrictive Pericarditis Lower Esophageal Sphincter Pressure 
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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of MedicineRobert Wood Johnson Medical School, Robert Wood Johnson University HospitalNew BrunswickUSA

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