Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis?

Diabetic autonomic neuropathy is a common complication of diabetes mellitus and affects every segment of the gastrointestinal tract. Gastrointestinal problems tend to be more common and severe in diabetics compared with the nondiabetic population. In the literature, the prevalence of reflux esophagitis is not known. The aim of this study was to analyze esophagoscopic findings, compare them with esophageal symptoms, and evaluate reflux esophagitis in relationship with autonomic neuropathy. We examined 54 diabetics (15 type 1, 39 type II), 28 males and 26 females, average age 55.4 (95% confidence intervals 52.1-58.8), with duration of diabetes more than 5 (average 15.0; 12.4-17.6) years. All patients completed a structured questionnaire. After overnight fasting, gastroesophageal endoscopy was performed in the morning to establish the presence of reflux esophagitis, using the Los Angeles classification. Cardiovascular autonomic neuropathy was diagnosed with the help of cardiovascular autonomic reflexes (deep breathing, active orthostasis, Valsalva's maneuver) and spectral analysis of heart rate variation. Endoscopic esophagitis was present in 22 (40.7%) diabetics and 10 of them (45 %) also complained of reflux symptoms. Sensitivity of symptoms was 45.5% and specificity was 72%. We found the presence of symptoms of reflux esophagitis in 21 (38.9%) diabetics, but of this group only 10 (47.6%) had endoscopic changes. Autonomic neuropathy was present in 29 patients, 16 (55%) of them had reflux esophagitis and 18 (62%) were positive for reflux symptoms. In the diabetics without autonomic neuropathy, esophagitis was noted in 6 (24%), which reflects a significant difference (p < 0.05). Reflux symptoms were present in 10 (40%) diabetics without autonomic neuropathy, and in comparison with patients who had autonomic neuropathy, the difference was not statistically significant. Thus, reflux eosophagitis is common in diabetic patients, with a prevalence of 40.7%. Reflux symptoms do not have a great diagnostic value in establishing reflux esophagitis. We confirmed a relationship between autonomic neuropathy and the clinical manifestations of reflux esophagitis, but no association with accompanying reflux symptoms. (Tab. 2, Ref. 27.)