title: Diabetic gastrointestinal motility disorders and the role of enteric nervous system: current status and future directions.
abstract: BACKGROUND
  Gastrointestinal manifestations of diabetes are common and a source of significant discomfort and disability. Diabetes affects almost every part of gastrointestinal tract from the esophagus to the rectum and causes a variety of symptoms including heartburn, nausea, vomiting, abdominal pain, diarrhea and constipation. Understanding the underlying mechanisms of diabetic gastroenteropathy is important to guide development of therapies for this common problem. Over recent years, the data regarding the pathophysiology of diabetic gastroenteropathy is expanding. In addition to autonomic neuropathy causing gastrointestinal disturbances the role of enteric nervous system is becoming more evident.
  
  
  OBJECTIVE
  In this review, we summarize the reported alterations in enteric nervous system including enteric neurons, interstitial cells of Cajal and neurotransmission in diabetic animal models and patients. We also review the possible underlying mechanisms of these alterations, with focus on oxidative stress, growth factors and diabetes induced changes in gastrointestinal smooth muscle. Finally, we will discuss recent advances and potential areas for future research related to diabetes and the ENS such as gut microbiota, micro-RNAs and changes in the microvasculature and endothelial dysfunction.
authors.affiliation: Division of Digestive Diseases, Emory University, Atlanta, GA; Atlanta VA Medical Center, Decatur, Georgia, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Yarandi
authors.forename: S
authors.initials: S
authors.lastname: Srinivasan
mesh_terms: D003929:Diabetic Neuropathies / Q000503:physiopathology*; D017615:Enteric Nervous System / Q000503:physiopathology*; D005767:Gastrointestinal Diseases / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D041981:Gastrointestinal Tract / Q000503:physiopathology; D006801:Humans; D009130:Muscle, Smooth / Q000503:physiopathology
keywords: diabetes; enteric nervous system; enteric neurons; interstitial cells of Cajal; oxidative stress; smooth muscle