medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2022-35-29-36medalphabet-2951Research ArticleСтатьиПатологические изменения органов желудочно-кишечного тракта у пациентов с сахарным диабетомPathological changes in the gastrointestinal tract in patients with diabetes mellitushttps://orcid.org/0000-0002-6890-8096АслановБ. И.AslanovB. I.

Асланов Батырбек Исмелович, д. м. н., проф., зав. кафедрой эпидемиологии, паразитологии и дезинфектологии

Санкт-Петербург

Aslanov Batirbek I., DM Sci (habil.), professor at head Dept of Epidemiology, Parasitology and Disinfectology

Saint Petersburg

Batyrbek.Aslanov@szgmu.ruhttps://orcid.org/0000-0002-8249-9903ЧиркинаТ. М.ChirkinaT. M.

Чиркина Татьяна Михайловна, к. м. н., ассистент кафедры эпидемиологии, паразитологии и дезинфектологии

Research ID: F-5612–2019

Санкт-Петербург

Chirkina Tatiana M., PhD, assistant at Dept of Epidemiology, Parasitology and Disinfectology

Research ID: F-5612–2019

Saint Petersburg

tatyana-chirkina@bk.ruhttps://orcid.org/0000-0003-3292-4438КоковинаЮ. В.KokovinaYu. V.

Коковина Юлия Владимировна, к. м. н., врач-гастроэнтеролог

Санкт-Петербург

Kokovina Yulia V., PhD Med, gastroenterologist

Saint Petersburg

jmozhelis@mail.ruАнтоноваЕ. А.AntonovaE. A.

Антонова Екатерина Александровна, студентка VI курса медико-профилактического факультета

Санкт-Петербург

Antonova Ekaterina A., 6th year student of Faculty of Preventive Medicine

Saint Petersburg

ekatrinalex@yandex.ruhttps://orcid.org/0000-0002-2512-833XТиселькоА. В.TiselkoA. V.

Тиселько Алена Викторовна, д. м. н., в. н. с., врач-эндокринолог

Scopus: 57194216306

Санкт-Петербург

Tiselko Alena V., DM Sci (habil.), senior researcher, endocrinologist

Scopus: 57194216306

Saint Petersburg

alenadoc@mail.ruШирайО. В.ShiraiO. V.

Ширай Ольга Владимировна, врач-эпидемиолог, нач. эпидемиологического отдела

Санкт-Петербург

Shiray Olga V., epidemiologist, head of Dept of Epidemiology

Saint Petersburg

shirayov@eliz-spb.ruhttps://orcid.org/0000-0002-6826-8922ИгнатоваО. К.IgnatovaO. K.

Игнатова Олеся Константиновна, врач-эпидемиолог

Санкт-Петербург

Ignatova Olesya K., epidemiologist

Saint Petersburg

olesya.ignatova2012@yandex.ruФГБОУ ВО «Северо-Западный государственный медицинский университет имени И. И. Мечникова» Минздрава РоссииРоссияNorth-Western State Medical University n. a. I. I. MechnikovRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии имени Д. О. Отта»РоссияScientific Research Institute of Obstetrics, Gynecology and Reproductology n. a. D. O. OttRussian FederationСПб ГБУЗ «Городская больница святой преподобномученицы Елизаветы»РоссияCity Hospital of the Holy Martyr ElizabethRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Петрова» Минздрава РоссииРоссияN.N. Petrov National Medical Research Center of OncologyRussian Federation202212012023035«Практическая гастроэнтерология» (4) Эпидемиология, инфекционные болезни, гигиена2936Copyright © Асланов Б.И., Чиркина Т.М., Коковина Ю.В., Антонова Е.А., Тиселько А.В., Ширай О.В., Игнатова О.К., 20232023Асланов Б.И., Чиркина Т.М., Коковина Ю.В., Антонова Е.А., Тиселько А.В., Ширай О.В., Игнатова О.К.Aslanov B.I., Chirkina T.M., Kokovina Y.V., Antonova E.A., Tiselko A.V., Shirai O.V., Ignatova O.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2951

Автономная нейропатия у пациентов с сахарным диабетом (СД) – ведущая причина поражения пищеварительного тракта. В результате хронической гипергликемии и высокой вариабельности глюкозы чаще всего нарушается работа пищевода, желудка, тонкого и толстого кишечника. Наиболее частым расстройством пищеварительной системы при СД является гастропарез. Клинические симптомы гастропареза имеют сходство с другими функциональными расстройствами пищеварительного тракта, что затрудняет дифференциальную диагностику с другими заболеваниями. Качество жизни этих пациентов ухудшается вследствие возникновения значительных трудностей в управлении постпрандиальной гликемией. Поскольку пациенты с СД достаточно часто страдают желчекаменной болезнью, в настоящем обзоре также рассмотрен вопрос о необходимости оперативного вмешательства и последующем влиянии холецистэктомии на развитие гастропареза у этих пациентов. Важно помнить, что после удаления желчного пузыря пациенты нуждаются в более тщательном контроле за уровнем глюкозы. Это позволит своевременно назначить сахароснижающую терапию и снизить риск развития гастропареза в будущем. Дополнительно затронут вопрос о влиянии коронавирусной инфекции на функциональное поражение пищеварительного тракта у пациентов с СД. Важное значение в терапии гастропареза имеет специальная диета. Исключение трудноусваиваемой клетчатки, жирной пищи, включение витаминных комплексов и нормализация микробиоты способствуют более медленному всасыванию глюкозы после приема пищи и лучшей компенсации заболевания. Основное терапевтическое значение играет своевременная диагностика гастропареза и нормализация уровня глюкозы.

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.

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The authors declare that there are no conflicts of interest present.