PloS one · 2018
Decline in perception of acid regurgitation symptoms from gastroesophageal reflux disease in diabetes mellitus patients.
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Sakitani Kosuke, Suzuki Nobumi, Ihara Sozaburo, Hirata Yoshihiro, Kawazu Shoji, Iwamoto Yasuhiko, Koike Kazuhiko
Аннотация
OBJECTIVES: To determine if a discrepancy exists between subjective symptoms and the grade of endoscopic gastroesophageal reflux disease (GERD) in diabetes mellitus (DM) patients.
METHODS: All 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.
RESULTS: In 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.
CONCLUSIONS: There 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.
METHODS: All 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.
RESULTS: In 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.
CONCLUSIONS: There 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.