Correlation of dyspeptic symptoms and endoscopic findings in diabetic patient

Abstract

Objective: We aimed to demonstrate the relationship between the endoscopically increased mucosal damage and the frequency of dyspeptic symptoms in patients with diabetes. Material and Methods: The 42 diabetic patients with dyspeptic complain and 40 healthy dyspeptic people were involved in this study and evaluated with video endoscopes. Diabetic patients when compared with the control group according to the endoscopic evaluation and Glasgow Dyspepsia Symptom Scoring System no significant difference had been detected. Results: The symptoms of the diabetic group and the control group were familiar and there was no significant difference between the frequencies of the symptoms in both groups. In dyspeptic diabetic patients a weak correlation between BMI and endoscopically detected hiatal hernia was reported. However there was no relation between BMI and the other gastrointestinal symptoms. Also there was no difference between the patients with neuropathy and without neuropathy in terms of endoscopic findings and gastrointestinal symptoms. Conclusion: Endoscopic findings of diabetic patient and non-diabetic control group were compared statistically. Although gastric ulcus was significantly higher in diabetic group, there was no significant difference between two groups in terms of other endoscopic findings. Hovewer, gastric ulcus frequency in diabetic group is higher,  there were no significant difference in terms of gastrointestinal symptoms, diabetic complications and glisemic control in patients with other endoscopic lesions when compared with the patients with gastric ulcus. Hiatal hernia frequency in diabetic patients was higher due to control group. In shed light on our findings, diabetic patients must be evaluated for the esophageal reflux symptoms.

Keywords

• Diabetes mellitus,Dyspepsia,Endoscopy

Kaynakça

1. 1. Harrison İç Hastalıkları Prensipleri , cilt 2, 2004, Nobel Kitabevleri, 2109-2137 (Çeviri Editörü: Prof.Dr.Yahya Sağlıker,2004).
2. 2. Talley NJ, Stanghellini V, Heading RC, Koch KL, Malagelada JR, Tytgat GN. Functional gastroduodenal disorders. Gut 1999;45 Suppl 2:1137-1142.
3. 3. Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958;48(4):797-812.
4. 4. Takeuchi K, Ueshima K, Ohuchi T, Okabe S. Induction of gastric lesions and hypoglycemic response by food deprivation in streptozotocin-diabetic rats. Dig Dis Sci 1994;39(3):626-634.
5. 5. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 2004;127(5):1592-1622.
6. 6. Calvet X, Bustamante E, Montserrat A, Roqué M, Campo R, Gené E, et al. Validation of phone interview for follow-up in clinical trials on dyspepsia: Evalution of the Glasgow Dyspepsia Severity Score and a Likert-scale symptoms test. Eur J Gastroenterol Hepatol 2000; 12: 949-953.
7. 7. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001;161(16):1989-1996.
8. 8. Koch CA, Uwaifo GI. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control? Eur J Gastroenterol Hepatol 2008;20(9):822-825.

9. 9. Bharucha AE, Batey-Schaefer B, Cleary PA, Murray JA, Cowie C, Lorenzi G, et al. Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus. Gastroenterology 2015;149:330–339.
10. 10. Schvarcz E, Palmer M, Ingberg CM, Aman J, Berne C. Increased prevalence of upper gastrointestinal symptoms in long-term type 1 diabetes mellitus. Diabet Med 1996;13(5):478-481.
11. 11. Eslick GD. Gastrointestinal symptoms and obesity: a meta-analysis. Obes Rev 2012;13(5):469-479.
12. 12. Jebbink HJ, Bravenboer B, Akkermans LM, vanBerge-Henegouwen GP, Smout AJ. Relationships between dyspeptic symptoms and gastrointestinal motility in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1993;36(10):948- 954.
13. 13. Malagelada JR, Rees WD, Mazzotta LJ, Go VL. Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol. Gastroenterology 1980;78(2):286-293.
14. 13. Stacher G, Lenglinger J, Bergmann H, Schneider C, Brannath W, Festa A, et al. Impaired gastric emptying and altered intragastric meal distribution in diabetes mellitus related to autonomic neuropathy? Dig Dis Sci 2003;48(6):1027-1034.
15. 14. Samsom M, Akkermans LM, Jebbink RJ, van Isselt H, vanBerge-Henegouwen GP, Smout AJ. Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus. Gut 1997;40(5):641-646.
16. 15. Holzapfel A, Festa A, Stacher-Janotta G, Bergmann H, Shnawa N, Brannath W, et al. Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration. Diabetologia 1999;42(12):1410-1412.
17. 16. Annese V, Bassotti G, Caruso N, De Cosmo S, Gabbrielli A, Modoni S, et al. Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus. J Clin Gastroenterol 1999;29(2):171-177.
18. 17. Lluch I, Ascaso JF, Mora F, Minguez M, Pena A, Hernandez A, et al. Gastroesophageal reflux in diabetes mellitus. Am J Gastroenterol 1999;94(4):919- 924.
19. 18. Sun XM, Tan JC, Zhu Y, Lin L. Association between diabetes mellitus and gastroesophageal reflux disease: A meta-analysis. World J Gastroenterol 2015;21(10):3085-3092.
20. 19. Kong MF, Horowitz M, Jones KL, Wishart JM, Harding PE. Natural history of diabetic gastroparesis. Diabetes Care 1999;22(3):503-507.
21. 20. Horowitz M, Fraser R. Disordered gastric motor function in diabetes mellitus. Diabetologia 1994;37(6):543-551.
22. 21. Alipour Z, Khatib F, Tabib SM, Javadi H, Jafari E, Aghaghazvini L, et al. Assessment of the Prevalence of Diabetic Gastroparesis and Validation of Gastric Emptying Scintigraphy for Diagnosis. Mol Imaging Radionucl Ther 2017;26(1):17-23.
23. 22. Khoshbaten M, Madad L, Baladast M, Mohammadi M, Aliasgarzadeh A. Gastrointestinal signs and symptoms among persons with diabetes mellitus. Gastroenterol Hepatol Bed Bench 2011;4(4):219-223.
24. 23. Spangeus A, El-Salhy M, Suhr O, Eriksson J, Lithner F. Prevalence of gastrointestinal symptoms in young and middle-aged diabetic patients. Scand J Gastroenterol 1999;34(12):1196-1202.
25. 24. Feldman M, Schiller LR. Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983;98(3):378-384.
26. 25. Anastasios R, Goritsas C, Papamihail C, Trigidou R, Garzonis P, Ferti A. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur J Intern Med 2002;13(6):376.
27. 26. Gentile S, Turco S, Oliviero B, Torella R. The role of autonomic neuropathy as a risk factor of Helicobacter pylori infection in dyspeptic patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 1998;42(1):41-48.
28. 27. Malecki M, Bien AI, Galicka-Latala D, Stachura J, Sieradzki J. The prevalance of Helicobacter pylori infection and types of gastritis in diabetic patients.The Krakow study. Exp Clin Endocrinol Diabetes 1996;104:365-369.
29. 28. Li JZ, Li JY, Wu TF, Xu JH, Huang CZ, Cheng D, et al. Helicobacter pylori Infection is Associated with Type 2 Diabetes, Not Type 1 Diabetes: An Updated Meta-Analysis. Gastroenterol Res Pract 2017;2017:5715403.
30. 29. Persico M, Suozzo R, De Seta M, Montella F, Torella R, Gentile S. Non-ulcer dyspepsia and Helicobacter pylori in type 2 diabetic patients: association with autonomic neuropathy. Diabetes Res Clin Pract 1996;31(1-3):87-92.
31. 31. Devrajani BR, Shah SZ, Soomro AA, Devrajani T. Type 2 diabetes mellitus: a risk factor for Helicobacter pylori infection: a hospital based case-control study. Int J Diabetes Dev Ctries 2010;30(1):22-26.