Clinical characteristics of patients with gastroesophageal reflux disease against type 2 diabetes mellitus, depending on the presence of obesity

Abstract

Objective — to reveal the features of the clinical course in patients with gastroesophageal reflux disease (GERD) depending on anthropometric indicators against the background of type 2 diabetes mellitus (DM2).
 Materials and methods. The study involved 100 patients, who were divided into 3 groups: group 1 consisted of 60 patients with DM2 in combination with GERD, group 2 included 20 patients with isolated GERD, and group 3 included DM2 patients. The patients of group 1 were additionally divided into 2 subgroups: 27 subjects with normal weight and 33 subjects with excessive body weight (EBW) or obesity of various degrees. The control group consisted of 20 practically healthy people. The distribution of patients by gender and age was carried out in accordance with the standards of the international classification of age periods of the World Health Organization, revised in 2015. From the total number of patients, 44 (44%) were men and 56 (56%) were women. Body mass index (BMI) was calculated according to the Quetelet formula. Endoscopic examination of the upper part of the gastrointestinal tract with targeted biopsy was performed with an esophagogastroduodenoscope with end optics «Olympus GIF Q 150­03» (manufacturer Olympus Europa SE & CO. KG, Japan). To increase the diagnostic value of esophagogastroduodenoscopy, methods of chromoscopy and pinch biopsy of the esophageal mucosa were used.
 Results. Comparison of GERD manifestations with account of anthropometric data revealed significant differences in the subgroups with normal weight and obesity (p <0.05). Gastroenterological complaints were not registered in 6 (26.1%) patients of the obesity subgroup (DM2 + GERD + obesity) and 8 (21.6%) patients of the non‑obese subgroup (DM2 + GERD). In the subgroup with obesity (DM2 + GERD + obesity), the significant differences (p <0.001) were detected in heartburn depending on the obesity stage. Heartburn in this subgroup occurred 7.4 times more often than in patients with normal weight compared to the subgroup without obesity (odds ratio 89.13% (95%CI 12.83—137.77) χ2=35.06; р <0.0001). Cardiac symptoms in patients with increased body weight were revealed 12.3 times more often vs. subjects with BMI less than 25 kg/m2 (odds ratio 5.0 (95% CI 1.58 ‑14.10); χ2=6.95; р=0.008).
 The presence of heartburn complaints at the 2nd stage of obesity (39±5 kg/m2) and its absence at normal body mass (28±2 kg/m2), p <0.001) have been established. Analysis of the dependence of the Helicobacter pylori contamination degree on the BMI value showed no statistically significant differences between the subgroups with normal body weight and subgroup with EBW and obesity. The highest contamination degree was found in group 1 (DM2 + GERD) with the same number of positive results in both subgroups, with and without obesity.
 Conclusions. It has been established that excessive body weight and obesity significantly affect the development and progression of gastroenterological complaints in patients with DM2 combined with GERD. The heartburn was more often registered in patients with DM2 with obesity, than in those with normal weight. Comparison of GERD findings with anthropometric data revealed significant differences between the subgroups with normal body weight and obesity (р <0.05). Heartburn in the obesity subgroup occurred 7.4 times more often.