Pathological changes in the gastrointestinal tract in patients with diabetes mellitus

Autonomic neuropathy in patients with diabetes mellitus (DM) is the leading cause of damage to the digestive tract. As a result of chronic hyperglycemia and high glucose variability, the esophagus, stomach, small intestine, and large intestine are most often affected. The most common disorder of the digestive system in diabetes is gastroparesis. Clinical symptoms of gastroparesis have similarities with other functional disorders of digestive tract, which complicates differential diagnosis with other diseases. Quality of life of these patients is worsened because of significant difficulties in managing postprandial glycemia. Since patients with diabetes are quite often affected by cholelithiasis, this review also considers the need for surgical intervention and the subsequent effect of cholecystectomy on the development of gastroparesis in these patients. It is important to remember that after gallbladder removal patients need more careful monitoring of glucose levels. This will allow timely prescription of antidiabetic therapy and reduce the risk of developing gastroparesis in the future. In addition, the effect of coronavirus infection on functional damage of the digestive tract in patients with diabetes is discussed. A special diet is important in the therapy of gastroparesis. Exclusion of hard-to-digest fiber, fatty foods, inclusion of vitamin complexes and normalization of microbiota contribute to slower glucose absorption after meals and better compensation of disease. The main therapeutic value is the timely diagnosis of gastroparesis and normalization of glucose levels.