Shakil Amer, Church Robert J, Rao Shobha S
Department of Family and Community Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, USA.
Am Fam Physician. 2008 Jun 15;77(12):1697-702.
Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications.
糖尿病的胃肠道并发症包括胃轻瘫、肠道病变（可导致腹泻、便秘和大便失禁）以及非酒精性脂肪性肝病。胃轻瘫患者可能出现早饱、恶心、呕吐、腹胀、餐后饱胀或上腹部疼痛。当排除其他病因且通过胃排空闪烁显像证实存在餐后胃潴留时，可诊断为糖尿病性胃轻瘫。只要有可能，患者应停用会加重胃动力障碍的药物；控制血糖水平；增加饮食中的液体含量；少食多餐；戒烟；减少不溶性膳食纤维、高脂肪食物和酒精的摄入。促动力药（如甲氧氯普胺、红霉素）可能有助于控制胃轻瘫的症状。糖尿病相关便秘和腹泻的治疗旨在采取支持措施并控制症状。非酒精性脂肪性肝病在肥胖和糖尿病患者中很常见。对于肝转氨酶水平升高的糖尿病患者，重要的是寻找肝病的其他病因，包括肝炎和血色素沉着症。逐渐减重、控制血糖水平以及使用药物（如吡格列酮、二甲双胍）可能使肝转氨酶水平恢复正常，但积极治疗非酒精性脂肪性肝病的临床益处尚不清楚。控制血糖水平对于管理大多数胃肠道并发症至关重要。
