Factors associated with gastro-duodenal ulcer in compensated type 2 diabetic patients: a Romanian single-center study

Abstract

IntroductionIntroduction: Helicobacter pylori infection is accepted as the leading cause of chronic gastritis, ulcer disease and gastric cancer, with an important impact on health care burden, especially in countries with a high prevalence of infection. The aim of the study was to investigate the influence of H. pylori infection, medication, associated medical conditions or social habits on endoscopic ulcer occurrence in the compensated type 2 diabetic population.Material and methodsTwo hundred and sixty type 2 diabetic patients investigated on endoscopy (57 patients with peptic ulcer and 203 controls) with a complete set of biopsies, demographic and medical data were enrolled.ResultsOn univariate regression analysis, H. pylori infection (42.1% vs. 35.5%, p = 0.359) or a history of peptic ulcer (61.4% vs. 61.6%, p = 0.981) was not a predictor for ulcer on endoscopy in the diabetic population, and heartburn was more frequent in diabetics without ulcer (21.2% vs. 8.8%, p = 0.033). Anemia was the best predictor for ulcer on endoscopy in both diabetics with (p < 0.001, OR: 4.77, 95% CI: 2.02–11.28) and without (p = 0.027, OR: 2.76, 95% CI: 1.10–6.91) chronic proton pump inhibitor (PPI) therapy. In diabetic patients on PPI more than 1 month anticoagulants – acenocoumarol or low-weight molecular heparin (p = 0.038, OR: 2.37, 95% CI: 1.04–5.40), low-dose aspirin 75–125 mg/day (p = 0.029, OR: 2.61, 95% CI: 1.08–6.28) and alcohol consumption (p = 0.015, OR: 2.70, 95% CI: 1.19–6.13) were predictors for ulcer on endoscopy.ConclusionsIn diabetic patients, anemia is the most important predictor for ulcer on endoscopy, but not H. pylori or digestive symptoms, while low-dose aspirin or anticoagulant therapy and alcohol consumption are the most important predictors for ulcer in diabetics on chronic proton pump inhibitor therapy.

A real-world retrospective study of omeprazole– domperidone combination in managing acid peptic disease with PRoton-pump Inhibitors in patients with type 2 DiabEtes mellitus (PRIDE-2)

“…3 In addition to well-established risks for microvascular and macrovascular complications amongst patients with DM, DM has also been recognized as a risk factor for complicated APD. 4 Damage to the enteric nervous system due to irreversible autonomic neuropathy or oxidative stress is believed to be the causal or contributing factor for gastrointestinal dysfunction amongst patients with DM. 5 The remarkable changes that are frequently observed in patients with DM are decreased gastric secretion and motility.…”