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Gastroesophageal Reflux Disease in Diabetics, an under Diagnosed Complication.

Heartburn is noted in 42% of patients with neuropathy versus 24% patients without neuropathy. In the Pathophysiology of GERD, a major mechanism that promotes reflux of gastric contents into esophagus is delayed gastric emptying, a frequent complication of diabetes with neuropathy. In a prospective study 150 type 2 diabetes patients between the ages of 18 and 82 attending a endocrine clinic were given a questionnaire to fill out. A junior physician helped the patients to understand the questions. The questionnaire included the presence of the 5 most frequent symptoms of GERD that included heartburn (at least 1/week), hoarseness of voice, chronic cough, chest pain and regurgitation. Patients with angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes were excluded. Data are expressed as Mean SD, Student t and Chi-square were used for statistical analyses.

40% (61/150) patients reported having at least one of the symptoms of GERD and 30% (45/150) reported having heartburn at least once a week. The prevalence of GERD and heartburn is higher in patients with neuropathy than in patients without neuropathy (P<0.05).

Although GERD affects only 14% of Americans, the overall prevalence of GERD symptoms in diabetics (30%) is much greater .

In type II diabetes, the prevalence of GERD symptoms is higher in patients with neuropathy (58.7%) than patients without neuropathy (32.7%).

Heartburn is noted in 42% of patients with neuropathy versus 24% patients without neuropathy. Since experience of heartburn is likely to be blunted by neuropathy the actual incidence of GERD may even be higher.

K Chandrarana, N Shan, X Wang, CS Pitchumoni. Div of Endocrinol and GI, St Peters Univ Hosp-RWJMS, New Brunswick, NJ –presented ENDO 2005

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