Decline in perception of acid regurgitation symptoms from gastroesophageal reflux disease in diabetes mellitus patients.

Kosuke Sakitani,Kazuhiko Koike,Shoji Kawazu,Sozaburo Ihara,Yasuhiko Iwamoto,Yoshihiro Hirata,Nobumi Suzuki,Roberto Coppola

doi:10.1371/journal.pone.0194466

Kosuke Sakitani, Kazuhiko Koike + Show 6 more

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https://doi.org/10.1371/journal.pone.0194466

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Abstract

ObjectivesTo determine if a discrepancy exists between subjective symptoms and the grade of endoscopic gastroesophageal reflux disease (GERD) in diabetes mellitus (DM) patients.MethodsAll 2,884 patients who underwent esophagogastroduodenoscopy completed the modified Gastrointestinal Symptom Rating Scale (GSRS), an interview-based rating scale consisting of 16 items including a question on acid regurgitation. Patients were divided into DM and non-DM groups (1,135 and 1,749 patients, respectively). GERD was diagnosed endoscopically and graded according to the Los Angeles classification. Grade B or more severe GERD was defined as severe endoscopic GERD. The intergroup GSRS score was compared statistically.ResultsIn severe endoscopic GERD patients, the prevalence of patients with a positive GSRS score in the acid regurgitation question was statistically lower in DM patients than non-DM patients. Of the 60 non-DM patients with severe endoscopic GERD, 40 patients (67%) had a positive GSRS score for acid regurgitation; however, of the 51 DM patients with severe endoscopic GERD, 23 patients (45%) had a positive GSRS score. Multivariate analysis showed that severe endoscopic GERD (OR: 2.01; 95% CI: 1.21–3.33; p = 0.0066), non-DM (OR: 0.74; 95% CI: 0.54–0.94; p = 0.0157), younger age (OR: 0.98; 95% CI: 0.97–0.99; p = 0.0125), and hiatal hernia (OR: 1.46; 95% CI: 1.12–1.90; p = 0.0042) were associated with acid regurgitation symptoms.ConclusionsThere is a discrepancy between subjective symptoms and endoscopic GERD grade in DM patients. The ability of DM patients to feel acid regurgitation may be decreased.

Highlights

The prevalence of diabetes mellitus (DM) is rapidly increasing and there is mounting evidence that DM enhances the risk of malignancies, including esophageal adenocarcinoma, which has a poor prognosis [1,2,3,4]
In severe endoscopic gastroesophageal reflux disease (GERD) patients, the prevalence of patients with a positive Gastrointestinal Symptom Rating Scale (GSRS) score in the acid regurgitation question was statistically lower in DM patients than non-DM patients
Of the 60 non-DM patients with severe endoscopic GERD, 40 patients (67%) had a positive GSRS score for acid regurgitation; of the 51 DM patients with severe endoscopic GERD, 23 patients (45%) had a positive GSRS score

Summary

Introduction

The prevalence of diabetes mellitus (DM) is rapidly increasing and there is mounting evidence that DM enhances the risk of malignancies, including esophageal adenocarcinoma, which has a poor prognosis [1,2,3,4]. It is critical to assess GERD because it may be the start of carcinogenesis, especially among patients at high risk of esophageal adenocarcinoma. GERD is diagnosed when mucosal changes are observed during endoscopy, and the Los Angeles (LA) classification is commonly used to grade the reflux esophagitis endoscopically [7, 8]. GERD is perceived and diagnosed by subjective symptoms such as heartburn and acid regurgitation [9, 10]. Subjective symptoms of GERD may be underestimated in DM patients [13, 14]. To the best of our knowledge, research on GERD that combines subjective symptoms and endoscopic findings in DM patients is insufficient. We aimed to examine if a discrepancy exists between subjective symptoms and endoscopic GERD grade in DM patients

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