Erosive GERD in Type II DM with Neuropathy But Not Without Neuropathy

Abstract

Objective: Type II DM was known to have higher prevalence of GERD. And recent studies have shown that neuropathy has effective role on the development of GERD symptoms in type II DM. But its pathogenesis is yet to be known fully. The aim of this study was to analyze the relationship between the evidence of GERD and symptoms of GERD in type II DM with neuropathy. Methods: In this prospective study, 100 voluntary patients with type 2 DM from the endocrine center who had given informed consent were enrolled, excluding those with a history of angina, COPD, asthma and sinusitis, and with medication history of ACEI and CCB. All patients were followed the three steps of examinations such as EMG, interview for GERD and GFS, in that order. They were asked about the presence of typical GERD symptoms and atypical GERD symptoms via questionnaire and then investigated the evidence of GERD via GFS by experienced endoscopist. The degree of esophagitis was assessed using the Los Angeles classification. Of 100 patients, 5 patients were excluded due to have infectious esophagitis or hiatal hernia. In analysis, we divided the patients into two groups based on presence or absence of peripheral neuropathy. Results: The average age of patients studied (n=95) was 59.3+/-9.1 years and the duration of DM was 9.3+/-5.9 years. The mean HbA1c level was 7.1+/-1.2% and the average waist circumference was 33+/-2.5 inch. There is no significant difference in the GERD symptoms between the type II DM with neuropathy and without neuropathy (23.6% vs. 22.8% of typical GERD symptoms and 34.2% vs. 33.3% of atypical GERD symptoms, P>0.05). But, the evidence of GERD by GFS is much more in type II DM with neuropathy than in type II DM without neuropathy (31.5% of erosive esophagitis of LA-A 7, LA-B 3 and Barrett 2 vs 10.5% of erosive esophagitis of LA-A 5 and LA-B 1, P< 0.05). Conclusion: Type II DM has higher prevalence of GERD symptoms than the general population whether to have neuropathy or not. In terms of neuropathy, type II DM with neuropathy is noted to have erosive GERD, while type II DM without neuropathy noted to have non-erosive GERD. Key words: type II DM, neuropathy, GERD, GFS