Author(s)

P. Kovacic, B. Jamar

Patient

female, 21 year(s)

The patient, with known insulin dependent diabetes mellitus (IDDM) type 1, presented with a 2-year history of intermittent vomiting.

The patient, with known insulin dependent diabetes mellitus (IDDM) type 1, presented with a 2-year history of intermittent vomiting. She did not complain of swallowing difficulties. Because of suspected gastroparesis an upper gastrointestinal series was performed.

Diabetes mellitus affects every organ system including the gastrointestinal tract, which is the organ with the largest surface in the body. Its motor, transport, secretory, storage and excretory functions are under the control of the autonomic nervous system. Virtually all diabetic gastrointestinal manifestations are either directly or indirectly related to autonomic neuropathy. Disordered motility, a consequence of parasympathetic disfunction, is the main gastriontestinal abnormality. A disturbance in vagal innervation is the reason for decreased smooth muscle tone and abnormal contractility.

In the oesophagus absence or decreased amplitude of the primary peristaltic wave, delay in oesophageal emptying and tertiary contractions are present, with decreased lower oesophageal sphincter pressure and consequently a higher incidence of gastroesophageal reflux. Most patients with oesophageal motility disorders do not have specific oesophageal symptoms.

Diabetic gastroparesis (DGP) is also known as gastric autonomic neuropathy. The majority of patients with DGP have long standing IDDM. The most common symptoms of DGP are nausea and vomiting, often of undigested food, ingested many hours earlier.