Diabetic diarrhea. A clinical and pathophysiological study.

Abstract

Thirteen patients with diabetic diarrhea were studied in order to obtain a clinical and pathophysiological description of this disorder. The patients already had debilitating complications of diabetes, such as neuropathy and occlusive vascular disease. The diarrhea was intermittent and an isolated absorption defect for fat was present in 5 of the 13 patients. Intestinal biopsies and pancreatic exocrine function were normal. No evidence was found of abnormal bacterial colonization of the upper gastrointestinal tract. Water and electrolyte absorption was normal in jejunum and ileum during continuous perfusion with normal saline. However, following the oral administration of d-xylose in water, the test meal gained in volume and its passage through the ileum was delayed. Lack of pain with jejunal distention indicated impairment of afferent sympathetic innervation. The efferent sympathetic and parasympathetic pathways appear to be intact in view of the normal response of intestinal motility to l -epinephrine, l -norepinephrine, and methacholine. These results are consistent with previously published autopsy studies showing degeneration of interneuronal pathways in the pre- and paravertebral sympathetic ganglia in diabetic diarrhea.