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Bất thường thực quản ở những bệnh nhân mắc bệnh tiểu đường là phổ biến, nhưng những gì là rõ ràng từ các nghiên cứu rằng, mặc dù tỷ lệ cao các rối loạn vận động thực quản trong bệnh tiểu đường, không có một sự gia tăng rõ ràng trong các triệu chứng thực quản. | OESOPHAGEAL COMPLICATIONS 173 ogy of diabetic gut symptoms. Recent functional imaging studies have looked at brain structure and function in patients with type I diabetes. It is known that acute hypoglycaemia has an acute detrimental effect on brain function 38 although a recent study suggests that recurrent exposure to severe hypoglycaemia in young people with type I diabetes mellitus has no detrimental effects on brain structure or function.39 Chronic hyperglycaemia inferred by the presence of diabetic retinopathy however does appear to have an effect on brain structure and function in that it is associated with small focal white matter changes in the basal ganglia and significant cognitive disadvantage.39 8.4 Oesophageal Complications Oesophageal abnormalities in patients with diabetes are common but what is clear from studies is that despite the high prevalence of disorders of oesophageal motility in diabetes there is not a clear increase in oesophageal symptoms. It is possible that this is due to a possible visceral afferent neuropathy in these patients. Motor abnormalities Oesophageal manometric and scintigraphic studies show that oesophageal transit is delayed in 40-60 per cent of diabetic patients with a decrease in amplitude and number of peristaltic waves and an increase in simultaneous and non-propagated waves.40 Rarely marked abnormalities of motility such as diffuse oesophageal spasm are seen in diabetic patients. Additionally lower oesophageal sphincter pressure is reduced compared with controls suggesting a predisposition to gastro-oesophageal reflux.41 It has been hypothesized that these effects are secondary to vagal neuropathy since the vagus is the major efferent supply to the oesophagus. In support of this there is demyelination and loss of Schwann cells in the parasympathetic fibres of long standing type I diabetic patients.42 Sensory abnormalities Decreased oesophageal sensory perception has been described in diabetic patients and may explain
