{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:47:31Z","timestamp":1776779251072,"version":"3.51.2"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Ruhr-University of Bochum","award":["FoRUM"],"award-info":[{"award-number":["FoRUM"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Aims Gastrointestinal disorders, including constipation and fecal\n                    incontinence, are common in type 2 diabetes mellitus (T2DM) and may derive from\n                    diabetic autonomic neuropathy, severe intestinal bacterial overgrowth, or a\n                    dysfunctional anorectal sphincter. The present study aims to characterize the\n                    correlation between these conditions.<\/jats:p><jats:p>\n          Methods Patients with T2DM, prediabetes, and normal glucose tolerance\n                    (NGT) were included. The anorectal function was assessed with high-resolution\n                    anorectal manometry. Patients were screened for autonomic neuropathy by\n                    measuring olfactory, sweat, and erectile dysfunction as well as heart rate\n                    variability. Constipation and fecal (in-)continence were evaluated using\n                    validated questionnaires. Breath tests were used to assess severe intestinal\n                    bacterial overgrowth.<\/jats:p><jats:p>\n          Results We included 59 participants (32 (54.2%) with T2DM, 9\n                    (15.3%) with prediabetes, and 18 (30.5%) NGT). The presence of\n                    autonomic neuropathy, severe bacterial overgrowth, and symptoms of constipation\n                    and incontinence were comparable. HbA1c was correlated with an\n                    increased anorectal resting sphincter pressure (r=0.31,\n                    P=0.019) and constipation symptoms (r=0.30,\n                        P=0.031). In patients with a long-standing diagnosis of T2DM,\n                    significantly higher values for maximum anorectal resting pressure\n                    (\u0394=+27.81\u00b17.84\u2009mmHg,\n                    P=0.0015) and baseline pressure\n                    (\u0394=20.50\u00b19.74\u2009mmHg, P=0.046) were\n                    found compared with NGT, but not with prediabetes.<\/jats:p><jats:p>\n          Conclusions Long-standing T2DM increases anorectal sphincter activity, and\n                    constipation symptoms are associated with higher HbA1c levels. The\n                    lack of an association of symptoms with autonomic neuropathy suggests\n                    glucotoxicity as the primary mechanism.<\/jats:p>","DOI":"10.1055\/a-2048-0952","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T02:10:31Z","timestamp":1678155031000},"page":"299-306","source":"Crossref","is-referenced-by-count":3,"title":["Digestive, Anorectal, and Urogenital Functions in Patients with Type\n                    2 Diabetes Mellitus, Impaired Glucose Tolerance and Normal Glucose Tolerance:\n                    Association with Autonomic Neuropathy"],"prefix":"10.1055","volume":"131","author":[{"given":"Daniel R","family":"Quast","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"},{"name":"Diabetes, Endocrinology and Metabolism Section, Department of Internal\n                    Medicine I, Ruhr-University Bochum, Gudrunstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios C","family":"Boronikolos","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bjoern A","family":"Menge","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas GK","family":"Breuer","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Schenker","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juris J","family":"Meier","sequence":"additional","affiliation":[{"name":"Diabetes Division, St Josef-Hospital, Ruhr-University Bochum,\n                    Gudrunstr. Bochum, Germany"},{"name":"Department of Internal Medicine, Gastroenterology and Diabetes, Augusta\n                    Clinic Bochum, Bergstr. Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.2337\/diacare.26.5.1553","article-title":"Diabetic autonomic neuropathy","volume":"26","author":"A I Vinik","year":"2003","journal-title":"Diabetes Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1001\/archinte.161.16.1989","article-title":"Prevalence of gastrointestinal symptoms associated with diabetes mellitus: A\n                    population-based survey of 15,000 adults","volume":"161","author":"P Bytzer","year":"2001","journal-title":"Arch Intern Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"627","DOI":"10.2337\/dc17-1536","article-title":"Gastrointestinal symptoms in diabetes: Prevalence, assessment, pathogenesis, and\n                    management","volume":"41","author":"Y T Du","year":"2018","journal-title":"Diabetes Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s10350-006-0838-1","article-title":"Diabetes mellitus and anal sphincter pressures: An experimental model in\n                    rats","volume":"50","author":"H S Fillmann","year":"2007","journal-title":"Dis Colon Rectum"},{"key":"ref5","first-page":"554","article-title":"Comparative value of anorectal manometry and electrocardiography in the\n                    diagnosis of diabetic autonomic neuropathy","volume":"10","author":"D Lejeune","year":"1986","journal-title":"Gastroenterol Clin Biol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1007\/bf02235035","article-title":"Impairment of anorectal function in diabetes mellitus parallels duration of\n                    disease","volume":"42","author":"E Epanomeritakis","year":"1999","journal-title":"Dis Colon Rectum"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/gut.41.4.494","article-title":"Acute hyperglycaemia affects anorectal motor and sensory function in normal\n                    subjects","volume":"41","author":"A Russo","year":"1997","journal-title":"Gut"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"46","DOI":"10.5056\/jnm15168","article-title":"How to perform and interpret a high-resolution anorectal manometry test","volume":"22","author":"T H Lee","year":"2016","journal-title":"J Neurogastroenterol Motil"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/mcg.0000000000000797","article-title":"Pathophysiology and therapeutic options for fecal incontinence","volume":"51","author":"A Guillaume","year":"2017","journal-title":"J Clin Gastroenterol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.gtc.2016.09.008","article-title":"Small intestinal bacterial overgrowth and other intestinal disorders","volume":"46","author":"U C Ghoshal","year":"2017","journal-title":"Gastroenterol Clin North Am"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s12291-016-0569-6","article-title":"Malabsorption, orocecal transit time and small intestinal bacterial overgrowth\n                    in type 2 diabetic patients: A connection","volume":"32","author":"S V Rana","year":"2017","journal-title":"Ind J Clin Biochem"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"628","DOI":"10.20452\/pamw.3501","article-title":"Small intestinal bacterial overgrowth in adult patients with type 1 diabetes:\n                    Its prevalence and relationship with metabolic control and the presence of\n                    chronic complications of the disease","volume":"126","author":"A Adamska","year":"2016","journal-title":"Pol Arch Med Wewn"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s10620-012-2426-7","article-title":"Small intestinal bacterial overgrowth in gastroparesis","volume":"59","author":"N S George","year":"2014","journal-title":"Dig Dis Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1002\/nau.23121","article-title":"Urinary incontinence in the Netherlands: Prevalence and associated risk factors\n                    in adults","volume":"36","author":"J M Linde","year":"2017","journal-title":"Neurourol Urodyn"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.2337\/dc21-S002","article-title":"2. 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Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1136\/gut.2005.075127","article-title":"Use and abuse of hydrogen breath tests","volume":"55","author":"M Simren","year":"2006","journal-title":"Gut"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1038\/s41586-020-2395-5","article-title":"A neurotransmitter produced by gut bacteria modulates host sensory\n                    behaviour","volume":"583","author":"M P O'Donnell","year":"2020","journal-title":"Nature"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"101507","DOI":"10.1016\/j.beem.2021.101507","article-title":"Gut microbiome, prebiotics, intestinal permeability and diabetes\n                    complications","volume":"35","author":"M Snelson","year":"2021","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.dsx.2018.11.009","article-title":"The impact of diabetes mellitus on Lower urinary tract symptoms (LUTS) in both\n                    male and female patients","volume":"13","author":"E Papaefstathiou","year":"2019","journal-title":"Diabetes Metab Syndr"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"108011","DOI":"10.1016\/j.jdiacomp.2021.108011","article-title":"Individualized HbA1c target selection and achievement in the Multinational\n                    Observational Study Assessing Insulin Use (MOSA1c) type 2 diabetes study","volume":"35","author":"A E Caballero","year":"2021","journal-title":"J Diabetes Complications"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2048-0952.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T22:35:43Z","timestamp":1684362943000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2048-0952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,6]]},"references-count":35,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2023,5,17]]},"published-print":{"date-parts":[[2023,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2048-0952","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3,6]]},"published":{"date-parts":[[2023,3,6]]}}}