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Diagnostik und Therapie gastrointestinaler Funktionsstörungen bei Diabetes mellitus

机译：糖尿病胃肠功能障碍的诊断和治疗

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摘要

Gastrointestinal functional disturbances frequently cause abdominal symptoms in patients with diabetes mellitus and have been shown to impair the quality of life. Autonomic neuropathy is an important pathomechanism but other disturbances affecting the enteric nervous system, interstitial cells of Cajal (ICC), smooth muscle cells, release of insulin and other regulatory peptide hormones and glucose homeostasis also contribute to the pathogenesis. Diagnostic procedures should start with exclusion of infectious and structural diseases by laboratory investigations, endoscopy, abdominal sonography and/or radiological methods. If the diagnosis remains unclear individual parameters decide whether a therapeutic trial can be started or whether functional diagnostic procedures are needed for further clarification. Optimization of blood glucose control is generally of importance but frequently difficult to achieve due to interactions between gastrointestinal dysfunction and blood glucose control. Apart from this, symptom-oriented therapy is usually performed as established for patients without diabetes. Moreover, diabetes-associated functional disturbances, particularly those affecting the proximal gastrointestinal tract, may cause few symptoms but may still impair blood glucose and therefore need therapy. In this article the diabetes-associated diseases dysphagia, reflux disease, gastropathy, exocrine pancreatic insufficiency, gallbladder dysfunction, diarrhea, constipation and stool incontinence are discussed with respect to the diagnostic procedures and therapy
机译：胃肠道功能障碍经常导致糖尿病患者的腹部症状，并已被证实会损害生活质量。自主神经病是一种重要的发病机制，但其他影响肠神经系统的疾病，Cajal的间质细胞（ICC），平滑肌细胞，胰岛素和其他调节性肽激素的释放以及葡萄糖的体内稳态也有助于发病。诊断程序应首先通过实验室检查，内窥镜检查，腹部超声检查和/或放射学方法排除传染性和结构性疾病。如果诊断仍不清楚，则各个参数决定是否可以开始治疗性试验或是否需要功能性诊断程序以进一步阐明。血糖控制的优化通常很重要，但由于胃肠功能障碍和血糖控制之间的相互作用，常常难以实现。除此之外，通常针对没有糖尿病的患者进行以症状为导向的治疗。此外，与糖尿病相关的功能障碍，尤其是那些影响近端胃肠道的功能障碍，可能很少引起症状，但仍可能损害血糖，因此需要治疗。在本文中，讨论了与糖尿病有关的吞咽困难，反流疾病，胃病，外分泌胰腺功能不全，胆囊功能障碍，腹泻，便秘和大便失禁的诊断方法和治疗方法

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