Boehme Michael W J, Autschbach Frank, Ell Christian, Raeth Ulrich
Wilhelm-Fresenius-Klinik/Dr. Horst-Schmidt-Kliniken, Department of Internal Medicine, Wiesbaden, Germany.
Hepatogastroenterology. 2007 Mar;54(74):643-8.
BACKGROUND/AIMS: Severe gastric inflammation or ulcer disease can alter gastric motility and influence sufficient glycemic control in patients with type 2 diabetes mellitus. However, visceral neuropathy may reduce the perception of typical gastrointestinal symptoms in these patients. The aim of the present study was to evaluate the prevalence of silent severe acute gastritis, gastric ulcers or erosions in asymptomatic patients with diabetes mellitus and to determine potential predictive parameters.
Seventy-two patients with type 2 diabetes mellitus and little or no dyspeptic symptoms were investigated by endoscopy of the upper gastrointestinal tract under screening conditions. Before endoscopy the presence of gastrointestinal symptoms and standard laboratory parameters were determined. In addition, the presence of Helicobacter pylori infection was investigated by rapid urease test and histology.
Highly active gastric inflammation was found in 34 patients (gastric ulcers in 10, gastric erosions in 21, and histologically acute, grade two or three gastritis in 3 patients). Episodic heartburn was significantly associated with highly active gastric inflammation (odds ratio 2.96 (1.05-8.32), p = 0.036). Elevated levels of C-reactive-protein and blood leukocyte counts proved to be of positive predictive value for highly active gastric inflammation in patients without other causes of acute inflammatory diseases (odds ratio 3.52 (p = 0.026) and 7.64 (p = 0.007) respectively). No significant association was found for gender, age, duration of disease, BMI, considerably raised HbA1c (>8.5%), complications of diabetic disease, general gastrointestinal symptoms, Helicobacter pylori infections and therapy with acetylsalicylic acid on 100 mg/d.
The results of this study indicate that severe acute gastric inflammation or ulcer disease can occur with high prevalence in patients with diabetes mellitus with little or no dyspeptic symptoms. Additional endoscopic investigations might be of particular diagnostic value in patients with inexplicable raised levels of inflammatory parameters like C-reactive-protein or blood leukocyte counts.
背景/目的：严重的胃炎或溃疡疾病可改变胃动力，并影响2型糖尿病患者的血糖充分控制。然而，内脏神经病变可能会降低这些患者对典型胃肠道症状的感知。本研究的目的是评估无症状糖尿病患者中无症状性严重急性胃炎、胃溃疡或糜烂的患病率，并确定潜在的预测参数。
对72例2型糖尿病且几乎没有或没有消化不良症状的患者在筛查条件下进行上消化道内镜检查。在内镜检查前，确定胃肠道症状和标准实验室参数。此外，通过快速尿素酶试验和组织学检查幽门螺杆菌感染情况。
34例患者发现有高度活动性胃炎（10例胃溃疡，21例胃糜烂，3例组织学上为急性二级或三级胃炎）。偶发性烧心与高度活动性胃炎显著相关（优势比2.96（1.05 - 8.32），p = 0.036）。在没有其他急性炎症性疾病原因的患者中，C反应蛋白水平升高和血白细胞计数被证明对高度活动性胃炎具有阳性预测价值（优势比分别为3.52（p = 0.026）和7.64（p = 0.007））。在性别、年龄、病程、体重指数、糖化血红蛋白显著升高（>8.5%）、糖尿病并发症、一般胃肠道症状、幽门螺杆菌感染以及每日服用100毫克阿司匹林治疗方面未发现显著关联。
本研究结果表明，在几乎没有或没有消化不良症状的糖尿病患者中，严重急性胃炎或溃疡疾病的患病率可能很高。对于炎症参数如C反应蛋白或血白细胞计数莫名升高的患者，额外的内镜检查可能具有特殊的诊断价值。
