| [Background and Aim]Type 2 diabetes mellitus(T2DM)is one of the most common chronic diseases and its prevalence has reached 12.7% in some regions of China.Our country may have the most diabetic patients in the world.DM has been linked to a higher incidence of gastrointestinal symptoms,including stomach ache,diarrhea,and constipation.In addition,experimental research has revealed that diabetes mellitus(DM)is characterized by intestinal hypomotility,gut microbial dysbiosis,increased gut permeability,microcirculation disorders and dysfunction of intestinal stem cells,which may be linked to injuries of intestinal mucosa.However,researches of the relationship between T2 DM and small intestinal mucosal injuries mainly focus on experimental research.Their relationship in clinical research,especially the relationship between T2 DM and macroscopic small intestinal mucosal injuries is still unclear.Therefore,we prepare to use capsule endoscopy to investigate the relationship between T2 DM and small intestinal mucosal injuries,in order to prove the definition of diabetic enteropathy and find a new strategy for the prevention,early diagnosis and treatment of diabetic enteropathy.[Materials and Methods]Inclusion criteria: inpatients who underwent CE due to occult gastrointestinal bleeding,abdominal pain,and diarrhea from August 2011 to January 2016 at the First Affiliated Hospital of Guangdong Pharmaceutical University.Exclusion criteria:(1)previous diagnosis of carcinoma;(2)recent use of NSAIDs;(3)previous diagnosis of Crohn's disease or suspected Crohn's disease;(4)gastrointestinal infection such as intestinal tuberculosis,acute gastroenteritis or intestinal parasites;(5)suspected small bowel obstruction or primary disease of intestinal;(6)serious heart,liver,lung or kidney(except diabetic nephropathy)disease;(7)incomplete medication data.Subject patient demographics and clinical characteristics,including gender,age,underlying diseases history,alcohol use and smoking status,capsule endoscopy findings and auxiliary examination findings were recorded.Patients are divided into T2 DM group or non-DM group based on their DM history,and their demographics and clinical characteristics were analyzed.A Chi-square test was used to assess the prevalence of different types of intestinal injuries between these two groups.The Mann-Whitney U-test to assess the Lewis scores between two groups and Lewis scores between different diabetic complications.The Spearman correlation test was used to evaluate the relationships between HOMA-IR value and Lewis score,and between HbA1 c level and Lewis score.[Results]1.Patient demographics and clinical characteristics,including gender,age and body mass index,excluding hypertension status,showed no statistical difference between the two groups.2.The prevalence of a villous edema in subjects with T2 DM was significantly higher than in those without DM(78.95% vs.42.76%,P < 0.001),but incidence of ulcers was not different(P = 1.000).3.With T2 DM,the Lewis score was also significantly higher [112(8-112)vs.0(0-112),P = 0.003].4.Patients with diabetic nephropathy showed significantly higher Lewis scores than patients without diabetic nephropathy(P = 0.033).In contrast,a history of cardiovascular or cerebrovascular complications,or diabetic peripheral neuropathy,did not appear to influence Lewis scores.5.The Lewis score showed no statistically significant difference between patients who used anti-diabetic drugs and those who did not(P = 0.831).In addition,the Lewis score also showed no statistically significant difference among patients with the use of oral anti-diabetic drugs,insulin,and both oral drugs and insulin(P = 0.579).6.The homeostasis model assessment of insulin resistance(HOMA-IR)value was correlated positively with the Lewis score(? = 0.141,P = 0.042),but no statistical correlation was found between HbA1 c level and Lewis score(P = 0.359).[Conclusions]T2DM is associated with significant small intestinal mucosal injuries.Our findings also suggest that if occult gastrointestinal bleeding,abdominal pain,and diarrhea are found in T2 DM,especially diabetic nephropathy patients who have been examined by gastroscopy and colonoscopy,it is imperative to ascertain by the use of CE whether these adverse events are a result of small intestinal mucosal injuries.Diabetic nephropathy may become a new indicator for capsule endoscopy examination.Moreover,weight loss can alleviate insulin resistance,and may also play an essential role for prevention and treatment of small intestinal mucosal injuries in patients with T2 DM. |
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