Clinical characteristics of gastroesophageal reflux disease in adolescents with diabetic cardiac autonomic neuropathy

Abstract

Aim. We evaluated the clinical and functional characteristics of gastroesophageal reflux disease (GERD) in adolescents with a cardiac form of diabetic autonomic neuropathy. Patients and methods. Fifty-two adolescents, aged 12?17 years, with type 1 diabetes were studied. Patients were divided into two groups according to the results of two autonomic tests (cardiointervalography and Valsalva test). Group 1 included 14 adolescents with a cardiac form of diabetic autonomic neuropathy. Group 2 included 38 controls. Oesophageal pH parameters were monitored over 24 h using a Gastroscan-24. The 24-h period was divided into day-time (08:00?22:00) and night-time (22:00?08:00) periods to eliminate the influence of exogenous factors (such as eating, physical activity and change of body position) on the oesophageal kinetic function. Results. Pathological gastroesophageal reflux occurred more frequently in Group 1 (78.5%) than in Group 2 (36.8%; p=0.018). Heartburn was experienced by 14.3% of the patients in Group 1 and generally occurred with similar frequency in the two groups (p=0.91). The daily amount of pathological acid reflux in Group 1 (86 [62?141]) was higher versus Group 2 (52.5 [24?108]; p=0.047) that was associated with night-time reflux in Group 1. A correlation analysis demonstrated the increase of frequency and intensity of the acid reflux due to development of parasympathetic insufficiency. Conclusion. Diabetic autonomic neuropathy in adolescents with type 1 diabetes appears to be a significant risk factor for the development of pathological subclinical GERD with altered daily pattern.