Diabetes is recognized by the World Health Organization (WHO) as a noninfectious epidemy. In clinical practice, 75% of patients with diabetes mellitus (DM) have symptoms of gastrointestinal tract organ damage. The issue of the combined course of digestive organ (DO) diseases, including gastroesophageal reflux disease (GERD) and diabetes is actively discussed in the scientific literature. Along with this, the factors influencing the course of GERD, its clinical and endoscopic features in patients with type II diabetes have not been sufficiently studied nowadays. The purpose of the study was to determine the features of endoscopic changes in GERD in patients with type II diabetes. Material and methods. The department of surgical diseases and propaedeutics of internal diseases examined 82 patients with type II diabetes with GERD during 2016-2017. The patients with type II diabetes were 44 males (53.7%) and 38 females (46.3%). The average age was 47.9±7.8. All of the studied patients were subjects to anthropometric, general clinic, laboratory and instrumental methods of investigation. The diagnosis of type II diabetes was made according to the recommendations of the International Diabetes Federation (IDF, 2005). GERD was diagnosed according to the criteria of the unified clinic protocol (Ministry of Health order ?943 dated 31.01.2013) taking into account complaints, endoscopic examination data, etc. For the endoscopic assessment of the esophagus extent, the Los Angeles (LA) classification was used (1998 ?.). The Helicobacter pylori (HP) infection was diagnosed with the help of rapid urease test (CLO-test) and ?13-urea breath testing (?13-UBT) (IZINTA, Hungary). The patients also underwent ultrasound examination of abdominal cavity organs (HDI-1500 device, USA), as well as electrocardiographic examination. The analysis and processing of the patients’ results were done with the help of a computer program Statistics for Windows v.7.0 (StatSoft Inc., USA) using parametric and non-parametric methods of gathered data evaluation. Results and discussion. The study group included patients with type II diabetes of moderate severity (subcompensated carbohydrate metabolism). Gastrointestinal complaints typical of GERD were detected in 61.0% of the examined patients with type II diabetes. The leading clinical manifestations of lesions of the upper digestive system in the examined patients with type II diabetes included acid regurgitation, globus pharyngeus, and epigastric burning. After a detailed analysis, it was found out that a part of patients with type II diabetes (up to 22.0%) often complained about throat irritation, hoarse voice, and dry cough. We additionally detected precordialgia in the course of the esophagus and abnormalities in cardiac performance in 17.1% of the examined patients with type II diabetes, who were consulted by a cardiologist. That was frequently manifested after consuming fatty, roasted food, carbonated beverages and coffee, which was initially regarded as extravascular manifestations of GERD. FGS study confirmed the diagnosis of GERD in all examined patients. In the process of the endoscopic examination, gastroesophageal reflux and reflux esophagitis (RE) of varying degrees of severity were observed in all patients. In the endoscopic study, it was noted that in patients with type II diabetes in the combination with GERD, regardless of the clinical form of the disease, the degree of severity of RE often corresponded to the LA-B and LA-C degrees. The endoscopic picture of patients with GERD having type II diabetes was characterized by generalized, persistent edema, mucous membrane hyperemia, along with multiple hemorrhagic elements. It was also found out that patients with type II diabetes often suffer from candidiasis esophagitis (especially in the case of GERD) – up to 24.0% of the examined patients. The feature of the endoscopic pattern in patients with extra-extravascular manifestations of GERD in the background of type II diabetes is the combination of gastro-esophageal and duodenal-gastric reflux (up to 59.4%). Conclusions. GERD in patients with type II diabetes often manifests itself in the exra-esophagus symptomatology. In patients with type II diabetes mellitus with the esophageal form of GERD, the characteristic endoscopic manifestations include reflux esophagitis and candidiasis esophagitis. In patients with type II diabetes with exra-esophagus form, GERD often manifests itself endoscopically with a combination of gastro-esophageal and duodenogastric reflux.
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Author Name: Sirchak Ye. S., Stan M. P., Pichkar Yo. I., Vajs V. V.
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Keywords: type II diabetes, gastroesophageal reflux disease, endoscopy