Table 2.

Potential management algorithm for patients presenting with suspected enteropathy

1. Patient presenting with suspected enteropathy

2. Clinical evaluation (e.g., type and nature of symptoms, acute/chronic/duration, presence of other GI symptoms, presence of other neuropathic symptoms/signs)

3. Investigate to exclude alternative causes (e.g., other bowel pathology, pancreatic insufficiency, functional infection)

4. Diagnosis of diabetic enteropathy confirmed

5. Initiate stepwise therapeutic strategy:

Step 1: Ensure adequate hydration and commence antidiarrheal agents (e.g., loperamide, codeine)  Step 2: Improve metabolic control.  Step 3: If symptoms persist despite implementing steps 1 and 2, therapeutic trial of antibiotic therapy (e.g., rifaximin)  Step 4: If symptoms persist despite implementing steps 1, 2, and 3, add somatostatin analogue (e.g., octreotide/lanreotide). Be aware these agents may influence blood glucose levels  Step 5: If pain is a major feature, then amitriptyline or pregabalin may provide benefit