Gastrointestinal abnormalities linked to diabetes
MedWire News: Patients with diabetes and high levels of glycated hemoglobin (HbA1c) have a higher prevalence of endoscopic abnormalities than the general population, despite having lower rates of gastrointestinal (GI) symptoms, report Taiwanese researchers.
"GI complications such as gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), which could affect quality of life and glycemic control in diabetic subjects, could occur undetected as a result of reduced pain," they explain in Diabetes Care.
The researchers say that although progress has been made in the diagnosis and management of diabetes in recent years, to date there is still no comprehensive report on GI manifestations in diabetes patients, and their association with glycemic control and diabetes complications.
Led by Ming-Shiang Wu (National Taiwan University Hospital, Taipei), the team recruited 7770 individuals undergoing upper endoscopy/colonoscopy between January and December 2009. They compared the GI symptoms, noninvasive GI testing results, and endoscopic findings between patients with and without diabetes, those with lower and higher HbA1c levels, and those with and without diabetic complications.
GI symptoms were assessed using a 10-item questionnaire and were further divided into esophageal (including dysphagia and acid reflux), upper GI symptoms (epigastralgia, postprandial fullness, nausea/vomiting/bloating, and belching), and lower GI symptoms (lower abdominal pain, constipation, and diarrhea).
The researchers report that 722 (9.3%) of the individuals were diagnosed with diabetes.
Compared with nondiabetic individuals, the presence of any GI symptom was significantly lower in those with diabetes, at 35.4% versus 30.3%.
Esophageal symptoms were reported in 10.1% of those without diabetes compared with 8.3% of those with the condition, and the corresponding figures for upper GI and lower GI symptoms were 20.8% versus 17.5%, and 18.4% versus 17.7%, respectively.
However, the endoscopic findings revealed that erosive esophagitis (inflammation of the esophagus) was more frequently detected in diabetic versus nondiabetic individuals, at 34.3% versus 28.6%, as was Barrett's esophagus (specialized columnar epithelium with intestinal metaplasia), at 0.6% versus 0.1%, and PUD at 14.8% versus 8.5%.
In addition, gastric neoplasms and colonic neoplasms were more prevalent among the diabetic patients than they were among those without the condtition, at 1.8% versus 0.7%, and 26.6% versus 16.5%, respectively.
Furthermore, analysis of the patients stratified by HbA1c level (<5.5, 5.5-5.9, and ≥6.0%) showed that higher HbA1c levels were associated with a decrease in GI symptoms and an increase in endoscopic abnormalities.
The researchers also found that patients with diabetic complications such as nephropathy and retinopathy had a higher frequency of colonic neoplasms than those without complications, at 39.2% versus 24.5%.
"Such discrepant GI manifestations highlight the realistic situation of frequent under-recognition of GI complications in diabetic subjects," write Wu and colleagues.
"Efforts toward better glycemic control and early detection of related GI disease to prevent the development of late complications in the diabetic population are warranted," they conclude.
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By Sally Robertson