Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

Wang, Xiangbing; Pitchumoni, C. S.; Chandrarana, Khushbu; Shah, Neha D.

doi:10.3748/wjg.14.709

Cited by 80 publications

(104 citation statements)

References 17 publications

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“…Embora haja controvérsias, esses sintomas não são considerados causas importantes de mortalidade em pacientes portadores da doença, mas também podem influenciar negativamente a saúde geral e a qualidade de vida 10,15,16 .…”

Section: Sintomas Gastrointestinais No Dmunclassified

Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

Rodrigues

Motta

2012

J Pediatr (Rio J)

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Objectives: To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents.Sources: Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases , as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. Summary of the findings:Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. Conclusions:There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus. J Pediatr (Rio J). 2012;88(1):17-24:Diabetes mellitus, digestive signs and symptoms, gastrointestinal motility, etiology, child, adolescent. ResumoObjetivos: Apresentar a frequência, os principais fatores causadores dos sintomas gastrointestinais em pacientes portadores do diabetes melito e controvérsias quanto à sua ocorrência em crianças e adolescentes. Fontes dos dados:Revisão não sistemática nas bases de dados MEDLINE/PubMed e SciELO (1983-2011), além de capítulos de livros relevantes. Foram selecionados os artigos mais atuais e representativos do tema. Síntese dos dados:A prevalência do diabetes melito vem aumentando ao longo dos anos em vários países do mundo. No sistema digestório, é conhecida a ocorrência de complicações do diabetes melito, entre elas os sintomas gastrointestinais (náuseas, vômitos, dor abdominal, azia, disfagia, constipação, diarreia e incontinência fecal). A patogênese das alterações das funções gastrointestinais no diabetes melito está ainda sob investigação, e o papel do sistema nervoso entérico e seus neurotransmissores tem ganhado significância. Em decorrência do comprometimento do sistema digestório, com danos ao sistema nervoso entérico, portadores do diabetes melito podem apresentar quadros específicos de distúrbios de motilidade, alguns de grande re...

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Section: Sintomas Gastrointestinais No Dmunclassified

Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

Rodrigues

Motta

2012

J Pediatr (Rio J)

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“…In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9)(10)(11)(12)(13)(14)(15). (18), GERD prevalence was found to be 40.7%. Increased BMI in most patients with diabetes may also contribute to the reflux.…”

Section: Systemic Sclerosismentioning

confidence: 99%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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Gastroesophageal reflux disease (GERD) is known to present with various extraesophageal symptoms and complications. In contrast, several diseases affecting the motility of the esophagus and some approaches that alter the upper gastrointestinal tract anatomy may result in GERD. Certain diseases and conditions often mentioned with GERD will be briefly discussed in this section. Systemic SclerosisEsophageal motility is impaired in 70-90% of patients with systemic sclerosis (1-3). On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5-7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8). As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9-15). Diabetes MellitusFurthermore, various factors showing tendency to GERD were identified in diabetes mellitus. Among these,• Reduced salivary secretion associated with diabetic neuropathy, • Delayed gastric emptying, • Decreased acid clearance due to reduced motor activity of the esophagus/stomach related motor/autonomic neuropathy, • Increased sensory thresholds associated with sensory nerve damage of the esophagus, • Acid regurgitation caused by the increased frequency of transient LES relaxations related to neuropathy, CholecystectomyThe reservoir function of the gallbladder disappears after cholecystectomy, and bile flow becomes continuous (20,21). Qualitative changes may appear at the levels of gastrointestinal hormones (22,23). Consequently, alterations in the qualitative bile content and more frequent transient LES relaxation may occur (24). Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data. Uyanıkoğlu et al. (26) used the impedance method and reported increased reflux after surgery and that the pH was <4% higher than that before surgery; however, it was similar to the control group. In another study, Lin et al. (27) compared patients with hernia surgery and cholecystectomy. Reduction in the reflux symptom score was 35% in patients, while it was 39% in controls (p=0.11). Sleeve GastrectomyMechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric em...

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“…In the second case, the patient had a past medical history of diabetes mellitus and was diagnosed with acute cerebral infarction, which may alter the motility of the esophageal sphincter and cause retention of the enteral formula. 10 Listed risk factors related to the patients in these two cases might have resulted in the esophageal obstruction observed in these two cases.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Obstruction Caused by the Solidification of Residue of an Enteral Feeding Formula

Jo¹,

Chang²,

Kim³

et al. 2018

J Clin Nutr

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The nutritional support of acutely ill patients is very important and early enteral nutrition is recommended. Feeding via the nasogastric route is used widely for its ease of access if the patient cannot maintain volitional food intake. If the position of the tip or side holes of the nasogastric tube (NGT) is above the gastroesophageal junction, there is the possibility of retention and solidification of the administered enteral feeding formula in the esophagus. Therefore, the tip of the NGT should be checked carefully; a chest radiograph to confirm its position can be considered, especially in patients with a higher risk of aspiration and gastroesophageal reflux. In addition, careful consideration of the risk factors that can trigger esophageal obstruction is required when feeding patients in the intensive care unit. This paper describes two unusual cases of esophageal obstruction caused by the solidification of residue of an enteral feeding formula.

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Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

Cited by 80 publications

References 17 publications

Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

Mechanisms and factors associated with gastrointestinal symptoms in patients with diabetes mellitus

Which diseases are risk factors for developing gastroesophageal reflux disease?

Esophageal Obstruction Caused by the Solidification of Residue of an Enteral Feeding Formula

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