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Acid-Related Upper Endoscopy Findings in Patients with Diabetes Versus Non-diabetic Patients

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Abstract

Background

The relationship between diabetes, GERD symptoms and acid-related mucosal damage has not been well studied.

Aims

To better quantify risk of acid-related mucosal damage among patients with and without diabetes.

Methods

A prospective study using 10 sites from the Clinical Outcomes Research Initiative (CORI) National Endoscopy Database surveyed patients undergoing EGD by telephone within 30 days on medical history, symptoms and demographics. Varices and feeding tube indications were excluded. Acid-related damage was defined as any of these findings recorded in CORI: Barrett’s esophagus; esophageal inflammation (unless non-acid-related etiology); healed ulcer, duodenal, gastric or esophageal ulcer; stricture; and mucosal abnormality with erosion or ulcer.

Results

Of 1,569 patients, 16% had diabetes, 95% being type 2. Diabetic patients were significantly more likely to be male, older and have a higher body mass index, and less likely to report frequent heartburn and non-steroidal anti-inflammatory drug use. No significant differences were found in acid reflux and proton pump inhibitor (PPI) use between groups. In unadjusted analyses, diabetic patients had a similar risk for acid-related damage than non-diabetic patients (OR 1.09; 95% CI: 0.83, 1.42) which persisted after adjusting for gender, age, acid reflux, acid indication and PPI use (OR 1.04; 95% CI: 0.79, 1.39).

Conclusions

No difference in risk of acid-related mucosal damage was found, even after adjustment for potential confounders. Our data do not support the need for a lower threshold to perform endoscopy in diabetic patients.

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Acknowledgments

The authors wish to acknowledge Dr. Linda Koo for her contribution to the study design. This project was supported with funding from NIDDK UO1 DK57132 and AstraZeneca. In addition, the practice network (Clinical Outcomes Research Initiative) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. Dr. Eisen is the co-director of the Clinical Outcomes Research Initiative (CORI), a non-profit organization that receives funding from federal and industry sources. The CORI database is used in this study. This potential conflict of interest has been reviewed and managed by the OHSU and Portland VAMC Conflict of Interest in Research Committee. Dr. Eisen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. CORI—OHSU Department of Gastroenterology, Oregon Health & Science University, 3303 SW Bond Ave, CH15C, Portland, OR, 97239, USA

    Jennifer L. Holub, LeAnn C. Michaels & J. Lucas Williams

  2. AstraZeneca LP, 1800 Concord Pike, PO Box 15437, Wilmington, DE, 19803-5437, USA

    Debra G. Silberg

  3. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA

    Cynthia D. Morris

  4. Department of Gastroenterology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L461, Portland, OR, 97239, USA

    Glenn Eisen

Authors
  1. Jennifer L. Holub
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  2. Debra G. Silberg
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  3. LeAnn C. Michaels
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  4. J. Lucas Williams
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  5. Cynthia D. Morris
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  6. Glenn Eisen
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Corresponding author

Correspondence to Jennifer L. Holub.

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Holub, J.L., Silberg, D.G., Michaels, L.C. et al. Acid-Related Upper Endoscopy Findings in Patients with Diabetes Versus Non-diabetic Patients. Dig Dis Sci 55, 2853–2859 (2010). https://doi.org/10.1007/s10620-010-1208-3

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  • DOI: https://doi.org/10.1007/s10620-010-1208-3

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