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Gastroesophageal reflux disease in diabetic patients: a systematic review

Gastroösophageale Refluxkrankheit bei Diabetikern: eine systematische Übersicht

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Zusammenfassung

GRUNDLAGEN: Diabetes mellitus (DM) und die Gastroösophageale Refluxkrankheit (GERD) sind in der westlichen Welt durch eine rasch steigende Inzidenz charakterisiert, die enorme Kosten verursachen. DM betrifft etwa 10% der Bevölkerung, während GERD-Symptome und Refluxösophagitis bei rund 40% bzw. 20% beschrieben wurden. METHODIK: Dieser Übersichtsartikel fasst den derzeitigen Wissensstand über GERD bei Diabetikern zusammen und legt ein besonderes Augenmerk auf Symptome, diagnostische Ergebnisse, pathophysiologische Zusammenhänge und Therapieoptionen. Der Evidenzgrad ist gering, da es sich bei den meisten Arbeiten um Fall-Kontrollstudien mit limitierter Patientenzahl (Evidenz-Level IIIb) und Fallserien (Evidenz-Level IV) handelt. ERGEBNISSE: Refluxsymptome werden bei rund 50% der Diabetiker beschrieben, wobei sie bei Patienten mit oraler antidiabetischer Therapie am stärksten ausgeprägt sind. Lang bestehende Krankheitsdauer, schlechte Blutzuckereinstellung mit erhöhten HbA1c-Werten und Übergewicht verstärken diese Beschwerden. Die erosive Ösophagitis betrifft mehr als 40% der Diabetiker mit einer höheren Prävalenz bei Vorliegen einer autonomen Neuropathie. PH-metrische Untersuchungen waren bei bis zu 90% symptomatischer Refluxpatienten pathologisch, während bislang widersprüchliche manometrische Ergebnisse beschrieben wurden. Vermehrte Magensäure-, verminderte Bikarbonat- und Speichelsekretion, gesteigertes Auftreten von transienten Sphinkterrelaxationen und ein verminderter Tonus des unteren Ösophagussphinkters sind an der Entstehung der Refluxkrankheit ebenso beteiligt wie verminderte Ösophagus- und Magenmotilität. Überdies ist die Heilung von Schleimhautverletzungen bei Diabetikern verzögert. Daten zur Therapie der GERD bei Diabetikern mittels Protonenpumpenihibitoren sind ebenso wenig verfügbar wie Studien über die interventionelle oder chirurgische Behandlung dieser Patienten. SCHLUSSFOLGERUNGEN: Es gibt einige Hinweise dafür, dass Diabetes, unabhängig von Adipositas, ein Risikofaktor für die Entstehung der GERD ist. Spezifische pathophysiologische Mechanismen sind für die Genese der GERD bei Diabetikern von Bedeutung, was die Notwendigkeit weiterer Studien unterstreicht.

Summary

BACKGROUND: Diabetes mellitus (DM) and gastroesophageal reflux disease (GERD) are characterized by a rapidly increasing incidence within the Western World causing incredible costs. DM affects about 10% of the population, whereas GERD symptoms and GERD related esophagitis have been reported in 40% and 20%, respectively. METHODS: This systematic review deals with the current knowledge on GERD in diabetic patients with special reference to symptoms, diagnostic outcomes, pathophysiologic characteristics and treatment strategies. The evidence level is low, as most of the contributions are individual case-control studies with limited number of patients (evidence level IIIb) and case series (evidence level IV). RESULTS: GERD symptoms are found in about 50% of diabetics being most pronounced among those taking oral hypoglycaemic agents. Prolonged duration of diabetes, low glycaemic control with increased HbA1c levels and obesity intensify these complaints. Erosive esophagitis affects more than 40% of diabetics, with a higher prevalence for those suffering from autonomic neuropathy. PH-metric abnormalities have been documented in up to 90% of diabetics with symptomatic GERD, whereas manometric findings are conflicting. Altered gastric acid, bicarbonate and salivary secretion, increased rates of transient lower esophageal sphincter relaxations and a hypotensive lower esophageal sphincter contribute to the genesis of GERD besides impaired esophageal and gastric peristalsis. Moreover, diabetic conditions cause delayed healing of mucosal injury. No data have been available on the effects of proton pump inhibitors in diabetic GERD patients, and there are no studies dealing with interventional or surgical treatment of these patients. CONCLUSIONS: There is some evidence that diabetes is an independent risk factor for the development of GERD not directly associated with obesity. Distinct pathophysiologic mechanisms are of importance for the genesis of GERD in diabetics raising the need for further studies.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    R. Promberger & C. Neumayer

  2. Department of Surgery, General Hospital of Krems, Krems, Austria

    M. Gadenstätter, R. Ciovica & G. Schwab

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  1. R. Promberger
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  2. M. Gadenstätter
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  3. R. Ciovica
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  4. G. Schwab
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  5. C. Neumayer
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Correspondence to C. Neumayer.

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Promberger, R., Gadenstätter, M., Ciovica, R. et al. Gastroesophageal reflux disease in diabetic patients: a systematic review. Eur Surg 39, 340–354 (2007). https://doi.org/10.1007/s10353-007-0366-9

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  • DOI: https://doi.org/10.1007/s10353-007-0366-9

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