Gastrointestinal involvement in patients with diabetes mellitus: Part I (first of two parts) - Epidemiology, pathophysiology, clinical findings

Zeitschrift fur Gastroenterologie

Volumn 37, Issue 9, 1999, Pages 803-815

  Folwaczny, C ^a   Riepl, R ^b   Tschop M ^b   Landgraf, R ^b  

^a LUDWIG MAXIMILIANS UNIVERSITY   (Germany)

^b NONE

Author keywords

Constipation; Diabetes mellitus; Diarrhea; Gastrointestinal transit; Gastroparesis; Hyperglycemia; Neuropathy

Indexed keywords

ARTICLE; CONSTIPATION; DIABETES MELLITUS; DIARRHEA; DIGESTIVE SYSTEM FUNCTION DISORDER; EPIGASTRIC PAIN; GALLBLADDER MOTILITY; GASTROINTESTINAL TRANSIT; HUMAN; HYPERGLYCEMIA; HYPOGLYCEMIA; NAUSEA; VOMITING; WEIGHT REDUCTION;

AUTONOMIC NERVOUS SYSTEM; CROSS-SECTIONAL STUDIES; DIABETES MELLITUS, TYPE 1; DIABETES MELLITUS, TYPE 2; DIABETIC NEUROPATHIES; DIGESTIVE SYSTEM; GASTROINTESTINAL DISEASES; GASTROINTESTINAL TRANSIT; HUMANS;

EID: 0032863662     PISSN: 00442771     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (154)

1. Bargen JA, Bollmann JL, Kepler EJ. The »diarrhea of diabetes« and steatorrhea of pancreatic insufficiency. Proc Mayo Clin 1936; 11: 737-42
2. Dyrberg T, Benn J, Christiansen JS et al. Prevalence of diabetic autonomie neuropathy measured by simple bedside tests. Diabetologia 1981; 20: 190-4
3. Jeyarajah R, Smarawickrama P, Jameel MM. Autonomic function tests in non-insulin dependent diabetic patients and apparently healthy volunteers. J Chronic Dis 1986; 39: 479-84
4. Burke CM, O'Doherty A, Flanagan A et al. Autonomic neuropathy in a diabetic clinic. Ir Med J 1984; 77: 202-5
5. Sharpey-Schafer EP, Taylor PJ, Absent circulatory reflexes in diabetic neuritis. Lancet 1960; 1: 559-62
6. Ewing DJ, Irving JB, Kerr F et al. Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: A test of autonomie function. Clin Sci Mol Med 1974; 46: 295-306
7. Drybert T, Benn J, Christiansen JS et al. Prevalence of diabetic autonomic neuropathy measured by simple beside tests. Diabetologia 1981; 20: 190-4
8. Pirart J. Diabetes mellitus and its degenerative complications: A prospective study of 4.400 patients observed between 1947 and 1973 (3rd and last part). Diab Metab 1977; 3: 245-56
9. Vegglio MP, Carpano-Maglioli P, Tonda L. Autonomic neuropathy in non-insulin dependent diabetes mellitus: Correlation with age, sex, duration and metabolic control of diabetes mellitus. Diab Metab 1990; 16: 200-6
10. Keshavarzian A, Iber FL, Nasrallah S. Radionuclide esophageal emptying and manometric studies in diabetes mellitus. Am J Gastroenterol 1987; 82: 625-31
11. Horowitz M, Maddox AF, Wishart JM et al. Relationship between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 1991; 18: 229-34
12. Mann NS, Mann SK. Celiac sprue and diabetes mellitus. J Clin Gastroenterol 1993; 16: 4-5
13. Horowitz M, Harding PE, Maddox AF et al. Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1989; 32: 151-9
14. Wegener M, Borsch G, Schaffstein J et al. Gastrointestinal transit disorders in patients with insulin-treated diabetes mellitus. Dig Dis 1990; 8: 23-36
15. Horowitz M, Wishart JM, Jones KE et al. Gastric emptying in diabetes: An overview. Diabet Med 1996; 13: S16-22
16. MacGregor I, Parent J, Meyer JH. Gastric emptying of liquid meals and pancreatic and biliary secretion after subtotal gastrectomy or truncal vagotomy and pyloroplasty in man. Gastroenterology 1977; 72: 195-205
17. Folwaczny C, Hundegger K, Volger C et al. Measurement of transit disorders in different gastrointestinal segments of patients with diabetes mellitus in relation to duration and severity of the disease by use of the metal-detector test. Z Gastroenterol 1995; 33: 517-26
18. Nowak TV, Johnson CP, Kalbfleisch JH et al. Highly variable gastric emptying in patients with insulin dependent diabetes mellitus. Gut 1995; 37: 23-9
19. Phillips WT, Schwartz JG, McMahan CA. Rapid gastric emptying of an oral glucose solution in type 2 diabetic patients. J Nucl Med 1992; 33: 1496-500
20. Jones KL, Horowitz M, Carney BI et al. Effects of cisapride on gastric emptying of oil and aqueous meal components, hunger, and fullness. Gut 1996; 38: 310-5
21. Baron JH, Nabarro JD. Pancreatic exocrine function in maturity onset diabetes mellitus. BMJ 1973; 4: 25-7
22. Feldman M, Schiller LR. Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983; 98: 378-84
23. Glouberman S. Diabetes mellitus and the gastrointestinal tract. II: Small and large intestine and gallbladder. Ariz Med 1977; 34: 174-5
24. Rundles RW. Diabetic neuropathy: General review with report of 125 cases. Medicine 1945; 24: 111-60
25. Horowitz M, Edelbroek M, Fraser R et al. Disordered gastric motor function in diabetes mellitus. Recent insights into prevalence, pathophysiology, clinical relevance, and treatment. Scand J Gastroenterol 1991; 26: 673-84
26. Horowitz M, Cunningham KM, Wishart JM et al. The effect of short-term dietary supplementation with glucose on gastric emptying of glucose and fructose and oral glucose tolerance in normal subjects. Diabetologia 1996; 39: 481-6
27. Maughan RJ, Leiper JB. Methods for the assessment of gastric emptying in humans: An overview. Diabet Med 1996; 13: S6-10
28. Schmidt H, Riemann JF, Schmid A et al. Ultrastructure of diabetic autonomie neuropathy of the gastrointestinal tract. Klin Wochenschr 1984; 62: 399-405
29. Ogbonnaya KI, Arem R. Diabetic diarrhea: Pathophysiology, diagnosis and management. Arch Intern Med 1990; 150: 262-7
30. Yoshida MM, Schuffler MD, Sumi SM. There are no morphologic abnormalities of the gastric wall or abdominal vagues in patients with diabetic gastroparesis. Gastroenterology 1988; 94: 907-14
31. Smith B. Neuropathology of the oesophagus in diabetes mellitus. J Neurosurg Psych 1974; 37: 1151-4
32. Kristensson K, Nordborg C, Olsson Y et al. Changes in the vagus nerve in diabetes mellitus. Acta Pathol Microl Scand 1971; 79: 684-5
33. Atkinson M, Hosking DJ. Gastrointestinal complications of diabetes mellitus. Clin Gastroenterol 1983; 12: 633-50
34. Maxton DG, Whorwell PJ. Functional bowel symptoms in diabetes: The role of autonomic neuropathy. Postgrad Med J 1991; 67: 991-3
35. Snape WJ. Myoeleotrical and motor activity of the colon in normal and abnormal status. Scand J Gaslroenterol (suppl.) 1984; 96: 55-60
36. Battle WM, Snape WJ, Alavi A et al. Colonic dysfunction in diabetes mellitus. Gastroenterology 1980; 79: 1217-21
37. Lysy J, Karmeli F, Goldin K. Substance P levels in the rectal mucosa of diabetic patients with normal bowel function and constipation. Scand J Gastroenterol 1993; 28: 49-52
38. Koshavarzian A, Dunne M, Iber FL. Gallbladder volume and emptying in insulin-requiring male diabetics. Dig Dis Sci 1987; 32: 824-8
39. Fraser RJ, Horowitz M, Maddox AF et al. Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990; 33: 675-80
40. Oster-Jorgensen E, Pedersen SA, Larsen ML. The influence of induced hyperglycemia on gastric emptying in healthy humans. Scand J Lab Clin Invest 1990; 50: 831-6
41. Hebbard GS, Reid K, Sun WM et al. Postural changes in proximal gastric volume and pressure measured using a gastric barostat. Neurogastroenterol Motil 1995; 7: 169-74
42. Hebbard GS, Sun WM, Dent J et al. Hyperglycaemia affects proximal gastric motor and sensory function in normal subjects. Eur J Gastroenterol Hepatol 1996; 8: 211-7
43. Barnett JL, Owyang C. Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 1988; 94: 739-44
44. Fraser R, Horowitz M, Dent J. Hyperglycaemia stimulates pyloric motility in normal subjects. Gut 1991; 32: 475-8
45. Fraser R, Fuller J, Horowitz M, Dent J. Effect of insulin-induced hypoglycaemia on antral, pyloric and duodenal motility in fasting subjects. Clin Sci 1991; 81: 281-5
46. Hasler WL, Soudah HC, Owyang C. Mechanisms by which octreotide ameliorates symptoms in the dumping syndrome. J Pharmacol Exp Ther 1996; 277: 1359-65
47. Kawagishi T, Nishizana Y, Okuno Y et al. Antroduodenal motility and transpyloric fluid movements in patients with diabetes studied with duplex sonography. Gastroenterology 1984; 107: 403-9
48. Schvarez E, Palmer M, Ingberg CM et al. Increased prevalence of upper gastrointestinal symptoms in long-term type 1 diabetes mellitus. Diabet Med 1996; 13: 478-81
49. Jebbink RJ, Samsom M, Bruijs PP et al. Hyperglycemia induces abnormalities of gastric myoelectrical activity in patients with type I diabetes mellitus. Gastroenterology 1994; 107: 1390-7
50. Hasler WL, Kurosawa S, Takahashi T et al. Bradykinin acting on B2 receptors contracts colon circular muscle cells by IP3 generation and adenylate cyclase inhibition. J Pharmacol Exp Ther 1995; 273: 344-50
51. Hasler WL, Kim MS, Chey WD et al. Central cholinergic and alpha-adrenergic mediation of gastric slow wave dysrhythmias evoked during motion sickness. Am J Physiol 1995; 268: G539-47
52. Hasler WL, Soudah HC, Dulai G et al. Mediation of hyperglycemia-evoked gastric slow-wave dysrhythmias by endogenous prostaglandins. Gastroenterology 1995; 108: 727-36
53. Fraser R; Horowitz M, Dent J. Hyperglycaemia stimulates pyloric motility in normal subjects. Gut 1991; 32: 475-8
54. Sims MA, Hasler WL, Chey WD et al. Hyperglycaemia inhibits mechanoreceptor-mediated gastrocolonic responses and colonie peristaltic reflexes in healthy humans. Gastroenterology 1995; 108: 350-9
55. Chey WD, Kim M, Hasler WL et al. Hyperglycemia alters perception of rectal distension and blunts the rectoanal inhibitory reflex in healthy volunteers. Gastroenterology 1995; 108: 1700-8
56. Eliasson B, Björnsson E, Urbanavicius V et al. Hyperinsulineamia impairs gastrointestinal motility and slows carbohydrate absorption. Diabetologia 1995; 38: 79-85
57. Dao T, Chee B, Bouvar G, Justum AM et al. Lack of modulation of gastric emptying by acute hyperglycemia in Type 2 diabetes mellitus. Gastroenterology 1990; 98: A342
58. Schvarez E, Palmer N, Aman J et al. Hypoglycemia increases the gastric emptying rate in healthy subjects. Diabetes Care 1995; 18: 674-6
59. Schvarez E, Palmer M, Aman J et al. Hypoglycaemia increases the gastric emptying rate in patients with type 1 diabetes mellitus. Diabet Med 1993; 10: 660-3
60. Russo A, Fraser R, Horowitz M. The effect of acute hypgerglycemia on small intestinal motility in normal subjects. Diahetologia 1996; 39: 984-9
61. Bjornsson ES, Urbanavicius V, Eliasson B et al. Effects of hyperglycaemia on interdigestive gastrointestinal motility in humans. Scand J Gastroenterol 1994; 29: 1096-104
62. De Boer SY, Masclee AA, Iam WF et al. Hyperglycemia modulates gallbladder motility and small intestinal transit time in man. Dig Dis Sci 1993; 38: 2228-35
63. Maleki D, Camilleri M, Zinsmeister AR et al. Effect of acute hyperglycemia on colorectal motor and sensory function in humans. Am J Physiol 1997; 273: G859-64
64. De Boer SY, Masclee AA, Lamers CB. Effect of hyperglycemia on gastrointestinal and gallbladder motility. Scand J Gastroenterol (suppl.) 1992; 194: 13-8
65. De Boer SY, Masclee AA, Lam WF et al. Effect of hyperglycemia on gallbladder motility in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1994; 37: 75-81
66. Dual RJ, Anderson DS, Forsythe AB et al. Treatment of diabetic diarrhea and orthostatic hypotension with somatostatin analogue SMS 201-995. Am J Med 1987; 83: 584-8
67. French JM, Hall G, Parish DJ et al. Peripheral and autonomie nerve involvement in primary amyloidosis associated with uncontrollable diarrhea and steatorrhea. Am J Med 1965; 39: 277-84
68. Miller LJ. Small intestinal manifestations of diabetes mellitus. Yale J Biol Med 1983, 56
69. Camilleri M, Malagelada JR. Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Invest 1984; 14: 420-7
70. Soudah HC, Hasler WL, Owyang C. Effect of octreotide on intestinal motility and bacterial overgrowth in scleroderma. N Engl J Med 1991; 325: 1461-7
71. Folwaczny C, Voderholzer W, Riepl R et al. Clinical presentation, pathophysiology, diagnostic procedures and therapeutic strategies in progressive-systemic sclerosis (PSS) with gastrointestinal involvement. Z Gastroenterol 1996; 34: 497-508
72. Whalen GE, Soergel KH, Geenen JE. Diabetic diarrhea: A clinical and pathophysiological study. Gastroenterology 1969; 56: 1021-31
73. 14C-glycocholate test in diabetic diarrhea. BMJ 1976; 2: 673-5
74. Fedorok RM, Field M, Chang EB. Treatment of diabetic diarrhea with clonidine. Ann Intern Med 1985; 102: 197-9
75. Schiller LR, Santa Ana CA, Morawski SG et al. Studies on the antidiarrheal action of clonidine. Effects on motility and intestinal absorption. Gastroenterology 1985; 89: 982-8
76. Chang EB, Fedorok RH, Field M. Experimental diabetic diarrhea in rats. Intestinal mucosal denervation hypersensitivity and treatment with clonidine. Gastroenterology 1986; 91: 564-9
77. Goyal RK, Spiro HM. Gastrointestinal manifestations of diabetes mellitus. Med Clin North Am 1971; 55: 1031-44
78. Chang EB, Bergenstal RM, Field M. Diabetic diarrhea: Loss of adrenergic regulation of intestinal fluid and electrolyte transport. Gastroenterology 1983; 84: A1121
79. Sanzenbacher LJ, Hagop S, Mekhjian HS et al. Studies on the potential role of secretin in the islet cell tumor diarrheogenic syndrome. Ann Surg 1972; 176: 394-402
80. Holst JJ. Neuronal control of pancreatic exocrine secretion. Eur J Clin Invest 1990; 20 (suppl. 1): S33-9
81. Holst JJ. Petidergic mechanisms in the pancreas. Arch Int Pharmacodyn 1990; 303: 252-69
82. Dockray GJ. Vasoactive intestinal polypeptide and related peptides. In: gut peptides - biochemistry and physiology. Walsh JH, Dockray GJ (eds.). New York, Raven Press, 1994, 447-72
83. Burnett N. Gastrin-releasing. In: gut peptides - biochemistry and physiology. Walsh, J. H., Dockray, G. J. (eds.). 1994, 423-46
84. Adler G, Beglinger C. Hormones as regulators of pancreatic secretion in man. Eur J Clin Invest 1990; 20 (suppl. 1): S27-S32
85. Leiter AB, Chey WY, Kopin AS. Secretin: In: gut peptides - biochemistry and physiology. Walsh JH, Dockray GJ (eds.). 1994, 147-74
86. Liddle RA. Cholecystokinin. In: gut peptides - biochemistry and physiology. Walsh, J. H., Dockray, G. J. (eds.). 1994, 176-216
87. Singer MV. Pancreatic secretory response to intestinal stimulants: A review. Scand J Gastroenterol 1987; 22 (suppl. 139): 1-13
88. Shetzlme MA, Liddle RA. Neurohumoral control of the exocrine pancreas. Curr Opin Gastroenterol 1996; 12: 423-8
89. Glasbrenner B, Dominguez E, Riepl RL et al. Cholecystokinin and pancreatic polypeptide release in diabetic patients with and without autonomic neuropathy. Dig Dis Sci 1995; 40: 406-11
90. Schwartz TW. Pancreatic polypeptide: A hormone and vagal cholinergic control. Gastroenterology 1983; 85: 1411-25
91. Kennedy FP, Go VL, Cryer PE et al. Supranormal pancreatic polypeptide and epinephrine responses to insulin-induced hypoglycemia identify patients with insulin-dependent diabetes mellitus predisposed to develop overt autonomie neuropathy. Ann Intern Med 1987; 108: 54-8
92. Kennedy FP. Pathophysiology of pancreatic polypeptide secretion in human diabetes mellitus. Diabet Nutr Metab 1989; 2: 155-63
93. Krarup T, Schwartz TW, Hilsted J et al. Impaired response of pancreatic polypeptide to hypoglycemia: An early sign of autonomie neuropathy in diabetics. BMJ 1979; 2: 1544-6
94. Mannon P, Taylor IL. The pancreatic polypeptide family. In: gut peptides - biochemistry and physiology. Walsh JH, Dockray GJ (eds.). 1994, 341-70
95. Catnach SM, Ballinger AB, Stevens M et al. Erythromycin induces supranormal gallbladder contraction in diabetic autonomie neuropathy. Gut 1993; 34: 1123-7
96. Hahm JS, Park JY, Park KG et al. Gallbladder motility in diabetes mellitus using real time ultrasonography. Am J Gastroenterol 1996; 91: 2391-4
97. Bucceri AM, Brogna A, Ferrara R. Sonographic study of postprandial gallbladder emptying and common bile duct changes in patients with diabetes or cholelithiasis. Abdom Imaging 1994; 19: 427-9
98. Onodera H, Sugawara H, Hirata T et al. Diurnal profile of gallbladder size in diabetic patients ultrasonographic evaluation of diabetic neurogenic gallbladder. Tohoku J Exp Med 1983; 139: 179-83
99. Werth B, Meyer Wyss B, Spinas GA et al. Non-invasive assessment of gastrointestinal motility disorders in diabetic patients with and without cardiovascular signs of autonomie neuropathy. Gut 1992; 33: 1199-203
100. Fiorucci S, Bosso F, Scionti L et al. Neurohormonal control of gallbladder motility in healthy subjects and diabetic patients with and without autonomic neuropathy. Dig Dis Sci 1990; 35: 1089-97
101. Sughihara HO, Nagata Y, Miyahara K et al. Ultrasonic examination of the contraction potential of the gallbladder in diabetic patients. J Kurume Med Ass 1983; 46: 509-13
102. Mitsukawa T, Takemura J, Ogho S et al. Gallbladder function and plasma cholecystokinin levels in diabetes mellitus. Am J Gastroenterol 1990; 85: 981-95
103. Loo FD, Dodda WJ, Soergel KH et al. Multipeaked esophageal peristaltic pressure waves in patients with diabetic neuropathy. Gastroenterol 1985; 88: 485-91
104. Horowitz M, Fraser R. Disordered gastric motor function in diabetes mellitus. Diabetologia 1994; 37: 543-51
105. Clouse RE, Lustman PJ, Reidel WL. Correlation of esophageal motility abnormalities with neuropsychiatric status in diabetics. Gastroenterology 1986; 90: 1146-54
106. Kelly KA. Gastric emptying of liquids and solids: Roles of proximal and distal stomach. Am J Physiol 1980; 239: G71-6
107. Malagelada JR, Rees WD, Mazzotta LJ, Go VL. Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: Effect of metroclopramide and bethanechol. Gastroenterology 1980; 78: 286-93
108. Ewe K, Press AG, Dederer W. Gastrointestinal transit of undigestible solids measured by metal detector EAS II. Eur J Clin Invest 1989; 19: 291-7
109. Fraser R, Horowitz M, Maddox A et al. Dual effects of cisapride on gastric emptying and antropyloroduodenal motility. Am J Physiol 1993; 264: G915-201
110. Fraser R, Fone D, Horowitz M et al. Cholecystokinin octapeptide stimulates phasic and tonic pyloric motility in healthy humans. Gut 1993; 34: 33-7
111. Fraser RJ, Horowitz M, Maddox AF et al. Postprandial antropyloroduodenal motility and gastric emptying in gastroparesis - effects of cisapride. Gut 1994; 35: 172-8
112. Schwartz JG, Green GM, Guan D et al. Rapid gastric emptying of a solid pancake meal in type II diabetic patients. Diabetes Care 1996; 19: 468-71
113. Phillips WT, Schwartz JG, McMahan CA. Rapid gastric emptying in patients with early non-insulin dependent diabetes mellitus. N Engl J Med 1990; 324: 130-1
114. Schwartz JG, Phillips WT, Green GM et al. Response to Lipp and Schnell (letter). Diabetes Care 1997; 20: 116
115. Lipp RW, Schnedl MD. Is rapid gastric emptying in Type II diabetic patients emptying the stomach in less time than in normal subjects? Diabetes Care 1997; 20: 116
116. Selzer HS, Allen EW, Herron Al et al. Insulin secretion in response to glycemic stimulus: Relation of delayed initial release to carbohydrate intolerance in mild diabetes. J Clin Invest 1967; 46: 323-35
117. De Fronzo RA, Ferrannini B. The pathogenesis of non-insulin dependent diabetes mellitus: An update. Medicine 1982; 61: 125-40
118. Bruce DG, Chisholm DJ, Storlien LH et al. Physiological importance of deficiency in early prandial insulin secretion in non-insulin dependent diabetes. Diabetes 1988; 37: 736-44
119. Phillips WT, Salman UA, McMahan CA et al. Accelerated gastric emptying in hypertensive subjects. J Nucl Med 1997; 38: 207-11
120. Mecklenbeck W, Rathmann W, Vosberg H. Gastric emptying in diabetic neuropathy: Two different forms of disturbed kinetics. Eur J Nucl Med 1991; 18: FP-3H3-1
121. Jones KL, Horowitz M, Wishart MJ et al. Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med 1995; 36: 2220-8
122. Mearin F, Cucala M, Azpiroz F et al. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 1991; 101: 999-1006
123. Samsom M, Salet GA, Roelofs JM et al. Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus. Dig Dis Sci 1995; 40: 2037-42
124. Tougas G, Hunt RH, Fitzpatrick D et al. Evidence of impaired afferent vagal function in patients with diabetes gastroparesis. Pacing Clin Electrophysiol 1992; 15: 1597-602
125. Malins JM, French JM. Diabetic diarrhoea. Q J Med 1957; 26: 467-80
126. Hodges FJ, Rundles RW, Hanelin J. Roentgenologic study of the small intestine. II. Dysfunction associated with neurologic disease. Radiology 1947; 49: 659-73
127. Dooley CP, El Newihi HM, Zeidler A et al. Abnormalities of the migrating motor complex in diabetics with autonomie neuropathy and diarrhea. Scand J Gastroenterol 1988; 23: 217-23
128. Lautenbacher S, Galfe G, Haslbeck M et al. Studies on orocecal transit in diabetes mellitus. Med Klin 1990; 85: 227-30
129. Taub S, Mariani A. Gastrointestinal manifestations of diabetes mellitus. Diabetes Care 1979; 2: 437-64
130. Enek P, Rathmann W, Spiekermann M et al. Prevalence of gastrointestinal symptoms in diabetic patients and non-diabetic subjects. Z Gatroenterol 1994; 32: 637-41
131. Leight RJ, Tumberg LA. Feacal incontinence: The unvoiced symptom. Lancet 1982; 1: 205-8
132. Erekenbrecht JF, Winter HJ, Cicmir I, Wienbeck M. Faecal incontinence in diabetes mellilus: Is it correlated to diabetic autonomie or peripheral neuropathy? Z Gastroenterol 1988; 26: 731-6
133. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 1984; 310: 1282-7
134. Vogelberg KH, Kubler HG, Cicmir J et al. Gallbladder contractility, cholelithiasis and autonomie neuropathy in diabetes mellitus. Dtsch Med Wochenschr 1984; 109: 1712-5
135. Bretzke G. Diabetes mellitus and exocrine pancreas function. Z Gesamte Inn Med 1984; 39: 388-90
136. Mossner J. Insulin - a regulator of exocrine pancreas function? Z Gastroenterol 1985; 23: 694-702
137. Attili AF, Pazzi P, Galeazzi R. Prevalence of previously undiagnosed gallstones in population with multiple risk factors. Dig Dis Sci 1995; 40: 1770-4
138. Bucceri AM, Brogna A, Ferrara R. Sonographic study of postprandial gallbladder emptying and common bile duct changes in patients with diabetes or cholelithiasis. Abdom Imaging 1994; 19: 427-9
139. Lowell JA, Stratta RJ, Taylor RJ et al. Cholelithiasis in pancreas and kidney transplant recipients with diabetes. Surgery 1993; 114: 858-63
140. Wilson IR, Hurrell MA, Pattinson NR et al. The effect of simvastatin and bezafibrate on bile composition and gallbladder emptying in female noninsulin-dependent diabetics. J Gastroenterol Hepatol 1994; 9: 447-51
141. Bennion LJ, Grundy SM. Risk factors for the development of cholelithiasis in man (first of two parts). N Engl J Med 1978; 299: 1161-7
142. Gitelson S, Oppenheim D, Schwartz A. Size of the gallbladder in patients with diabetes mellitus. Diabetes 1969; 18: 493-8
143. Bloom AA, Stachenfeld R. Diabetic cholecystomegaly. JAMA 1969; 208: 357-9
144. Fridhandler TM, Davison JS, Shaffer EA. Defective gallbladder contractility in the ground squirrel and prairie dog during the early stages of cholesterol gallstone formation. Gastroenterology 1983; 85: 830-6
145. Trendle MC, Moertel CG, Kvols LK. Incidence and morbidity of cholelithiasis in patients receiving chronic octreotide for metastatic carcinoid and malignant islet cell tumors. Cancer 1996; 79: 830-4
146. Bray GA. Health hazards of obesity. Endocrinol Metab Clin North Am 1996; 25: 907-19
147. Gorsky RD, Pamuk E, Williamson DF et al. The 25-year health care costs of women who remain overweight after 40 years of age. Am J Prev Med 1996; 12: 388-94
148. Chapman BA, Wilson IR, Frampton CM et al. Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 1996; 41: 2222-8
149. De Santis A, Attili AF, Corradini SG et al. Gallstones and diabetes: A case-control study in a free-living population sample. Hepatology 1997; 25: 787-90
150. Haber GB, Heaton KW. Lipid composition of bile in diabetics and obesity-matched controls. Gut 1979; 20: 518-22
151. Clave RA, Caspar MR. Incidence of gallbladder disease after vagotomy. Am J Surg 1969; 118: 109-76
152. Ketover SR, Ansel HJ, Goldish G et al. Gallstones in chronic spinal cord injury: Is impaired gallbladder emptying a risk factor? Arch Phys Med Rehabil 1996; 77: 1136-8
153. Walsh DB, Eckhauser FE, Ramsburgh SR et al. Risk associated with diabetes mellitus in patients undergoing gallbladder surgery. Surgery 1982; 91: 254-7
154. Gentile S. Asymptomatic choledocholithiasis associated with diabetic neuropathy. Report of a case. Clin Ther 1994; 144: 461-5