Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and pathophysiologic aspects - a retro-pro study

BMC Gastroenterol. 2013 Aug 23;13:132. doi: 10.1186/1471-230X-13-132.

Abstract

Background: Information about gastro-oesophageal reflux disease (GERD) in patients with Diabetes mellitus type 2 (T2D) is scarce, although the incidence of both disorders is increasing.

Methods: This "retro-pro" study compared 65 T2D patients to a control group of 130 age- and sex-matched non-diabetics. GERD was confirmed by gastroscopy, manometry, pH-metry and barium swallow.

Results: In patients with T2D compared to controls, dysphagia (32.3% vs. 13.1%; p = 0.001) and globus sensation (27.7% vs. 13.8%; p = 0.021) were found more frequently, whereas heartburn (76.9% vs. 88.5%; p = 0.046) and regurgitation (47.7% vs. 72.3%; p= 0.001) were predominant in non-diabetics. Despite higher body mass indices (31.1 ± 5.2 vs. 27.7 ± 3.7 kg/m²; p < 0.001), hiatal hernia was less frequent in T2D patients compared to controls (60.0% vs. 90.8%, p < 0.001). Lower oesophageal sphincter (LES) pressure was higher in patients with T2D (median 10.0 vs. 7.2 mmHg, p = 0.016). DeMeester scores did not differ between the groups. Helicobacter pylori infections were more common in T2D patients (26.2% vs. 7.7%, p = 0.001). Barrett metaplasia (21.5% vs. 17.7%), as well as low- (10.8% vs. 3.8%) and high-grade dysplasia (1.5% vs. 0%) were predominant in T2D patients.

Conclusions: T2D patients exhibit different GERD symptoms, higher LES pressures and a decreased prevalence of hiatal hernia than non-diabetics, which may be related to worse oesophageal motility and, thus, a more functional rather than anatomical cause of GERD. Low-grade dysplasia was more than twice as high in T2D than in non-diabetics patients.

Trial registration: Ethics committee of the Medical University of Vienna, IRB number 720/2011.

MeSH terms

  • Barium Sulfate
  • Case-Control Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Endoscopy, Gastrointestinal
  • Esophagus / diagnostic imaging
  • Esophagus / physiopathology
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnostic imaging
  • Gastroesophageal Reflux / physiopathology*
  • Helicobacter Infections / complications
  • Helicobacter pylori
  • Humans
  • Hydrogen-Ion Concentration
  • Manometry
  • Monitoring, Physiologic
  • Pressure
  • Prospective Studies
  • Radiography
  • Retrospective Studies

Substances

  • Barium Sulfate