[5th Nationwide Diabetology Symposium. Diabetes and Gastroenterology. Hrádec Králové, 6-7 July 2003].

Vnitr Lek 2004, 50(5):337-414

[Gastrointestinal complications in diabetes mellitus].

J Perusicová

Vnitr Lek 2004, 50(5):338-343

Impaired function of the gastrointestinal tract related to diabetes mellitus (DM) results from diabetic autonomous neuropathy, impaired sensory innervation and a direct effect of chronic hyperglycaemia. Another possible connection between DM and the gastrointestinal tract can be infrequent autoimmune diseases associated with type I DM (celiac disease, autoimmune gastropathy, autoimmune chronic pancreatitis). Functional or organic changes resulting from diabetes can be seen in every organ of the gastrointestinal tract. Some of the diabetic gastrointestinal tract difficulties affect almost 60% of patients with long lasting diabetes. On one side, impaired...

[Dysmotility disorders of the stomach and possible methods of diagnosis].

M Kopácová, J Bures

Vnitr Lek 2004, 50(5):344-349

Gastric dysmotility disorders are markedly heterogeneous group of gastrointestinal tract disorders and their etiology vary substantially. Some clinical manifestations of gastric dyspepsia can be present but they could be clinically silent, too. The authors give an overview of recent possibilities of dysmotility disorders diagnostics and of their relation to diabetes mellitus.

[Clinical importance of Helicobacter pylori infection in patients with diabetes mellitus].

J Bures, A Smahelová, M Kopácová, S Rejchrt

Vnitr Lek 2004, 50(5):350-353

This paper provides a review of current literature on Helicobacter pylori infection in diabetes mellitus. According to majority of studies there is no difference of Helicobacter pylori infection prevalence between diabetes mellitus and general population. There is no role of Helicobacter pylori in etiopathogenesis of diabetes. The only finding of Helicobacter pylori itself has not been an indication for eradication therapy in diabetes. In case of anti-helicobacter therapy (due to another indication) eradication rate is lower in diabetics (compared to non-diabetics) and there is a higher risk of re-infection (compared to general population). Several...

[A diabetic visceral neuropathy].

J Olsovský

Vnitr Lek 2004, 50(5):354-357

The article concentrates on an issue of a diabetic autonomous neuropathy (DAN) in the gastrointestinal tract (GIT). It points out etiopathogenesis of diabetic polyneuropathy. It presents autonomous neuropathy in an overview where it also in more detail discusses this issue in the GIT. It highlights clinical picture and possible diagnostic and therapeutic ways of affecting individual parts of the gastrointestinal tract.

[Prokinetics and diabetes mellitus].

R Keil

Vnitr Lek 2004, 50(5):358, 360

Dyspeptic upper gastrointestinal symptoms and delayed gastric emptying occur frequently in patients with diabetes mellitus. Prokinetics are drugs which are used in medical treatment of motility disorders in patients with diabetes. Itopride hydrochloride is the optimal drug for the therapy of motility disorders in diabetics.

[Diabetic diet and reduction diet are worthy of a basic discussion of their paradigms].

M Andel, L Brunerová, L Popová, P Dlouhý, F Duska, V Smejkalová, V Stich, J Potocková, P Kraml

Vnitr Lek 2004, 50(5):363-370

Present knowledge of etiopathogenesis of various types of diabetes postulate substantial differences between type I and type II diabetes. Whereas type I diabetes results from autoimmune destruction of pancreatic B-cells and subsequent absolute lack of insulin, type II diabetes is connected with insulin resistance and frequently with rather relative lack of sometimes absolutely elevated plasmatic insulin. From the viewpoint of the diet therapy an access to both types of diabetes fairly differs. Whilst in type I diabetes it is necessary to find out relationship among preprandial insulin dose, received carbohydrates, and expected physical activity soon...

[Gastric banding and diabetes mellitus].

S Svacina

Vnitr Lek 2004, 50(5):371-374

Gastric banding is one of the most important measures in type II diabetes mellitus prevention and treatment. It decreases risk of diabetes development 32 times within 2 years and 5 times 8 years after the procedure. In diabetes treatment the gastric banding is the most effective measurement in morbidly obese diabetics. According to one study 82.9% of diabetics and 98.7% of patients with impaired glucose tolerance had 14 years after gastric banding normal levels of blood sugar and glycosylated hemoglobin. Our experience also shows an important effect of gastric banding on diabetes although weight loss is lower compared to nondiabetics. This important...

[Diabetes mellitus in chronic pancreatitis].

J Perusicová

Vnitr Lek 2004, 50(5):375-378

Diabetes mellitus (DM) in chronic pancreatitis (ChP) is considered a unique clinical and metabolic unit. Compared to type I DM it has many different properties: glycemic lability, more frequent hypoglycaemic episodes, and minimum incidence of ketoacidosis. The need of insulin administration to achieve satisfying diabetes mellitus compensation is significantly lower and response of peripheral tissues to endogenous and exogenous insulin significantly higher compared to type I diabetics. These clinical differences result from decreased but always preserved insulin secretion, decreased glucagon production, impaired external pancreatic secretion, and also...

[Diabetes mellitus and liver diseases].

M Kvapil

Vnitr Lek 2004, 50(5):379-382

Diabetes mellitus is a independent risk factor for the hepatitis C and for the hepatocellular carcinoma. Fatty liver is a obviously finding in patients with type 2 diabetes. It can develop steatofibrosis, steatohepatitis or liver cirrhosis. Steatohepatitis may be affected with weight reduction, metformin, rosiglitazon, or orlistat.

[The gall bladder, biliary tract, and diabetes mellitus].

R Keil

Vnitr Lek 2004, 50(5):383-385

Patients with diabetes mellitus are known to have a two- to threefold increased risk of cholesterol gallstones. Several reports indicate, that impaired gallbladder emptying could be one of the important factors in the increased incidence of gallstones in diabetics. The mechanism of the gallbladder emptying abnormality in diabetics is not completely understood. It could be a manifestation of denervation cause by visceral neuropathy.

[Gastrointestinal tract cancer and diabetes mellitus].

S Svacina, M Matoulek, S Svobodová, V Visokai, L Lipská, O Topolcan, J Zvárová, M Plavcová

Vnitr Lek 2004, 50(5):386-391

Risk of development of some gastrointestinal tract cancers (colorectal cancer, pancreas cancer and liver cancer) is higher in type II diabetics. Another important risk factor is obesity (for gall bladder cancer in women and in men also for stomach and esophageal cancer). Pathogenetic factors have been explored especially in colorectal cancer (diet, hyperinsulinaemia, metabolic receptors activation, absence of physical activity). Our Czech study also proved up to 4 times increased risk of colorectal cancer in diabetics and, in accordance with literature, probable influence of persistent diabetes on tumour development. Type II diabetes mellitus should...

[Endocrine system of the gastrointestinal tract. Pathophysiology with a clinical view].

J Skrha

Vnitr Lek 2004, 50(5):392-398

Present role of the hormones produced in the gastrointestinal tract is shown in this short overview. Selected actual information on glucose-dependent insulinotropic peptide (GIP), glucagon-like peptide-1 (GLP-1) and somatostatin is presented as an example in development of the knowledge of pathophysiology and of the possibilities in their clinical use. It is evident that hormones originating from the gastrointestinal tract are perspective not only in relationship to the explanation of pathophysiology of different diseases but they may be used more for diagnostic and therapeutic purposes.

[Acute pancreatitis].

E Havel

Vnitr Lek 2004, 50(5):399-403

Acute pancreatitis is an insidious inflammatory disease of the pancreas with its serious form leading to mortality in 20 to 30% of patients. Seemingly good clinical state at the onset of the disease is the cause of underestimation of resuscitation care in first hours of the disease. Whereas a basic prevention of the development of multiorgan dysfunction are an early re-establishing of the microcirculation and supranormal hemodynamic values. Making a differential diagnosis of the mild and the severe form of pancreatitis is possible after several days of intensive resuscitation care. Treatment of complications of acute pancreatitis, especially a long-term...

[Acute complications of diabetes and the gastrointestinal tract].

A Smahelová

Vnitr Lek 2004, 50(5):404-407

Acute metabolic decompensation of diabetes, hypoglycemia and gastrointestinal tract disease are often connected. Hyperglycemic crisis can be induced by an infectious disease of the gastrointestinal tract, ulcerative disease, gall bladder disease, pancreas disease, and gastrointestinal tract tumours. It can result from diabetic visceral neuropathy manifested especially by impaired patency of the gastrointestinal tract. Metabolic decompensation of diabetes is often accompanied by gastrointestinal symptoms and abnormal laboratory findings. Some of them (especially abdominal pain and increased levels of amylases in serum) can evoke diagnostic and therapeutic...

[Immunopathogenesis of diabetes mellitus I].

J Krejsek, J Novosad, O Kopecký

Vnitr Lek 2004, 50(5):408-411

The pathogenesis of diabetes mellitus I is multifactorial. Both genetic predisposition and environmental factors are involved in the deregulation of immune system with subsequent breakage of self-tolerance. Autoantibodies against numerous autoantigens are raised during this long-term process but the principal pathogenic mechanism is cytotoxic killing of beta cells of pancreas mediated predominantly by T cells. There could be the chance to interrupt this pathogenetic process by manipulation with immune system to achieve induction of tolerance. Such clinical trials are now under progress.

[Diabetes and celiac disease].

O Pozler, D Neumann

Vnitr Lek 2004, 50(5):412-414

Celiac sprue is permanent lifelong intolerance of gluten which in some sensitive individuals leads to an inflammation of various grades followed by atrophy of jejunum mucosa. Diagnosis of celiac sprue is based on proof of histopathological changes in jejunum mucosa as a result of presence of gluten in food. In recent years, serum endogenous myosin and tissue transglutaminase antibodies were used in a diagnostic algorithm. We distinguish active, silent, latent, and potential celiac sprue. Simultaneous incidence of type I diabetes mellitus and celiac sprue has been documented in a range of studies. Both diseases have common immunology and genetic characters....