Modern aspects of the treatment of patients with gastroesophageal reflux disease against the background of type 2 diabetes mellitus and obesity

Abstract

This review presents new pathogenetic concepts of type 2 diabetes mellitus (DM 2) and gastroesophageal reflux disease (GERD) against the background of obesity and methods of therapeutic correction of these nosologies. The important role in the etiology of adipocytokines (ghrelin and leptin) and overweigh has been proved, the latter also may be DM 2 predictor. The interaction between indicators of these adipocytokines is described, which equates to normal and pathological deviations, according to the literature. The formation and progression of metabolic syndrome (MS), onset of insulin resistance (IR) and DM 2, and progression of complications against DM 2 background are stipulated by a violation of ghrelin and leptin biorhythms. This review describes the effects of prolonged hyperglycemia on the nervous system with further diabetic neuropathy (DN) formation, which causes diabetic gastroparesis. Possibilities of these pathogenic factors to affect function of the lower esophageal sphincter (LES) against the DM 2 background and the formation of GERD in future have been revealed. The analysis has been performed for the data on comorbid pathology (GERD against the DM 2 background), and possible predictors of the formation or progression of symptoms, specific for gastrointestinal pathology, have been identified. The efficacy of such measures to attenuate manifestation of GERD and DM 2 as lifestyle modification, dosed physical exercises, change in body position, normalization of nutrition etc., have been proved. In accordance with modern concepts and data of meta‑analysis, the possibilities of therapeutic correction of changes in carbohydrate metabolism at DM 2 are highlighted. It has been established that it is not always possible to achieve an adequate glycemic control against the background of metformin monotherapy. The most important medications’ groups have been described, advisable of the treatment of GERD and DM 2 as both separate pathologies and combined course. The information on the use of thioctic acid against the background of the formation of oxidative stress in patients with DM 2 and the positive effects of reducing the manifestations of diabetic neuropathy and GERD was analyzed.