Esophageal motor manifestations in diabetes mellitus

Vela, Andrew; Balart, Louis

doi:10.1016/0002-9610(70)90005-x

Cited by 36 publications

(9 citation statements)

References 5 publications

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“…In healthy subjects, marked hyperglycaemia decreased LES pressure [80]. Similar results have been described for diabetics [35,52] with up to 92% of patients with resting LES pressures between 0 and 8 mmHg [52]. However, two other studies failed to show an association between DM and a lower LES pressure, with no difference for the type of diabetes or the presence of NP [20,82].…”

Section: Hypotensive Lower Esophageal Sphincterssupporting

confidence: 66%

“…HbA 1c levels, however, did not significantly influence esophageal contraction amplitudes and mean resting pressure of the LES, although type I diabetics and those with high HbA 1c levels tended to have the lowest contraction amplitudes and the lowest resting pressures [35]. Likewise, no correlation between incidence of esophageal dysfunction and patients' symptoms, age and duration of diabetes has been described in a comparable cohort of patients previously [52]. In spite of that, decreased tonicity and impaired relaxation of the LES has been reported in 25 diabetics without esophageal symptoms or NP [52].…”

Section: Esophageal Manometrymentioning

confidence: 56%

“…Likewise, no correlation between incidence of esophageal dysfunction and patients' symptoms, age and duration of diabetes has been described in a comparable cohort of patients previously [52]. In spite of that, decreased tonicity and impaired relaxation of the LES has been reported in 25 diabetics without esophageal symptoms or NP [52].…”

Section: Esophageal Manometrymentioning

confidence: 90%

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Gastroesophageal reflux disease in diabetic patients: a systematic review

et al. 2007

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Gastroösophageale Refluxkrankheit bei Diabetikern: eine systematische Ü bersichtZusammenfassung. Grundlagen: Diabetes mellitus (DM) und die Gastroö sophageale Refluxkrankheit (GERD) sind in der westlichen Welt durch eine rasch steigende Inzidenz charakterisiert, die enorme Kosten verursachen. DM betrifft etwa 10% der Bevö lkerung, wä hrend GERDSymptome und Refluxö sophagitis bei rund 40% bzw. 20% beschrieben wurden.Methodik: Dieser Ü bersichtsartikel fasst den derzeitigen Wissensstand ü ber GERD bei Diabetikern zusammen und legt ein besonderes Augenmerk auf Symptome, diagnostische Ergebnisse, pathophysiologische Zusammenhä nge 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 stä rksten ausgeprä gt sind. Lang bestehende Krankheitsdauer, schlechte Blutzuckereinstellung mit erhö hten HbA 1c -Werten und Ü bergewicht verstä rken diese Beschwerden. Die erosive Ö sophagitis betrifft mehr als 40% der Diabetiker mit einer hö heren Prä valenz bei Vorliegen einer autonomen Neuropathie. PH-metrische Untersuchungen waren bei bis zu 90% symptomatischer Refluxpatienten pathologisch, wä hrend bislang widersprü chliche manometrische Ergebnisse beschrieben wurden. Vermehrte Magensä ure-, verminderte Bikarbonatund Speichelsekretion, gesteigertes Auftreten von transienten Sphinkterrelaxationen und ein verminderter Tonus des unteren Ö sophagussphinkters sind an der Entstehung der Refluxkrankheit ebenso beteiligt wie verminderte Ö sophagus-und Magenmotilitä t. Ü berdies ist die Heilung von Schleimhautverletzungen bei Diabetikern verzö gert. Daten zur Therapie der GERD bei Diabetikern mittels Protonenpumpenihibitoren sind ebenso wenig verfü gbar wie Studien ü ber die interventionelle oder chirurgische Behandlung dieser Patienten.Schlussfolgerungen: Es gibt einige Hinweise dafü r, dass Diabetes, unabhä ngig von Adipositas, ein Risikofaktor fü r die Entstehung der GERD ist. Spezifische pathophysiologische Mechanismen sind fü r die Genese der GERD bei Diabetikern von Bedeutung, was die Notwendigkeit weiterer Studien unterstreicht.Schlü sselwö rter: Gastroö sophageale Refluxkrankheit (GERD), Diabetes mellitus, Hyperglykä mie, Neuropathie, Ü bergewicht.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 ca...

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Section: Hypotensive Lower Esophageal Sphincterssupporting

confidence: 66%

Section: Esophageal Manometrymentioning

confidence: 56%

Section: Esophageal Manometrymentioning

confidence: 90%

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Gastroesophageal reflux disease in diabetic patients: a systematic review

et al. 2007

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“…Oesophageal motor dysfunction, characterised by a reduction in the primary peristaltic wave with frequent spontaneous contractions has been demonstrated in patients with diabetes mellitus by manometric and radiological techniques (Vix, 1969;Silber, 1969;Mandelstam et al, 1969;Vela & Balart, 1970;Horgan & Doyle, 1971;Stewart et al, 1976;Hollis et al, 1977). Oesophageal dysfunction is relatively common in diabetes mellitus, may be asymptomatic and is often associated with peripheral neuropathy (Hollis et al, 1977).…”

Section: Introduction Methodsmentioning

confidence: 99%

The effect of domperidone on oesophageal emptying in diabetic autonomic neuropathy.

Maddern¹,

Horowitz²,

Jamieson³

1985

Brit J Clinical Pharma

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1 Oesophageal emptying of solids was studied with a scintigraphic technique in 12 patients with insulin dependent diabetes complicated by autonomic neuropathy and in 22 control subjects. 2 In the diabetics the acute and chronic effects of oral domperidone on oesophageal emptying and symptoms of heartburn and dysphagia were assessed. 3 The number of swallows required to clear the oesophagus in the diabetics (median 9.5, range 2-30) was significantly greater (P < 0.001) than in normal controls (median 2, range 1-14). 4 Domperidone did not increase solid oesophageal emptying in diabetic patients either after acute or after chronic administration.

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“…5 Diabetic esophageal dysfunction is clinically important because it may be associated with delayed transit of meals and oral drugs, and gastrointestinal symptoms may decrease the patient's quality of life. [3][4][5][6][7] Common disturbances with respect to esophageal function include reduced amplitude of esophageal contractions, [8][9][10][11][12][13] fewer peristaltic waves, 8,10,14 a decrease in the velocity of peristalsis, 8,15 increased numbers of spontaneous, spastic, and repetitive contractions, [8][9][10][15][16][17] increased frequency of abnormal peristalsis, 12,13,17,18 appearance of multipeaked peristaltic waves, 10,17,19 reduced lower esophageal sphincter (LES) pressure, 8,11,16,20 impaired esophageal transit, 7,12,14,16,17,[20][21][22][23] and abnormal gastroesophageal refl ux. 10,13,…”

Section: Introductionmentioning

confidence: 99%