Lluch I, Ascaso J F, Mora F, Minguez M, Peña A, Hernandez A, Benages A
Department of Gastroenterology, Hospital Clínico Universitario, University of Valencia, Spain.
Am J Gastroenterol. 1999 Apr;94(4):919-24. doi: 10.1111/j.1572-0241.1999.987_j.x.
Although abnormal gastroesophageal (GE) reflux is the most frequent alteration of the gastrointestinal tract, its prevalence in diabetes mellitus (DM) is not widely known. The objective of this study was to analyze both the presence of abnormal GE reflux in diabetic patients with no esophageal symptoms and the influence of cardiovascular autonomic neuropathy (CVAN) in the development of abnormal GE reflux.
Fifty insulin-dependent diabetic patients, averaging 29.2 +/- 9.0 yr of age, who had had diabetes for > 5 yr and showed no symptoms or history of gastroesophageal disease, were compared with a control group composed of 36 healthy volunteers (18 men, 18 women) whose average age was 35.9 +/- 10.1 yr. The cardiovascular autonomic nervous system was examined in the diabetics and control subjects who complied with inclusion criteria. Long-term (24-h) ambulatory esophageal pH monitoring was performed, as well as a manometric study of the lower esophageal sphincter.
The parameters obtained from the monitoring showed significant differences (p < 0.01) between DM and control subjects. Abnormal GE reflux, defined as any percentage of time with esophageal pH < 4 exceeding 3.5% of total time (8.7 +/- 5.6%; range, 4.1-24.4%), was detected in 14 patients. Diabetic subjects were classified according to cardiovascular autonomic neuropathy tests (without CVAN [n = 19, 38%] and with abnormal CVAN tests [n = 31, 62%]). The pH monitoring parameters showed significant differences between these two groups (p < 0.05).
A higher prevalence (28%) of abnormal GE reflux appeared among asymptomatic diabetic patients than among the general population. The presence of abnormal GE reflux in diabetic patients was associated with the existence of cardiovascular autonomic neuropathy (abnormal GE reflux = 38.7% in diabetic patients with abnormal CVAN tests vs 10.5% in diabetic patients without CVAN).
尽管胃食管反流异常是胃肠道最常见的改变，但其在糖尿病（DM）中的患病率尚不为人所知。本研究的目的是分析无食管症状的糖尿病患者中胃食管反流异常的存在情况以及心血管自主神经病变（CVAN）对胃食管反流异常发展的影响。
将50名平均年龄为29.2±9.0岁、糖尿病病程超过5年且无胃食管疾病症状或病史的胰岛素依赖型糖尿病患者与由36名健康志愿者（18名男性，18名女性）组成的对照组进行比较，对照组平均年龄为35.9±10.1岁。对符合纳入标准的糖尿病患者和对照受试者进行心血管自主神经系统检查。进行了24小时动态食管pH监测以及食管下括约肌测压研究。
监测获得的参数显示糖尿病患者与对照受试者之间存在显著差异（p<0.01）。在14名患者中检测到胃食管反流异常，定义为食管pH<4的时间百分比超过总时间的3.5%（8.7±5.6%；范围为4.1 - 24.4%）。糖尿病受试者根据心血管自主神经病变测试进行分类（无CVAN[n = 19，38%]和CVAN测试异常[n = 31，62%]）。这两组之间的pH监测参数显示出显著差异（p<0.05）。
无症状糖尿病患者中胃食管反流异常的患病率（28%）高于一般人群。糖尿病患者中胃食管反流异常的存在与心血管自主神经病变有关（CVAN测试异常的糖尿病患者中胃食管反流异常为38.7%，无CVAN的糖尿病患者中为10.5%）。
