| Objective:The objective of this study is to investigate the characteristics of esophageal reflux in patients with diabetes mellitus complicated with gastroesophageal reflux disease(GERD)and the related risk factors of esophageal reflux,and to explore the influence of control related risk factors on esophageal reflux.Methods:A total of 482 patients who was diagnosed as GERD in the department of gastroenterology in Dalian central hospital and underwent 24-hour esophageal p H monitoring from January 2014 to December 2020,252 patients with diabetes mellitus were selected as diabetes mellitus complicated with GERD group,and 230 patients with simple GERD were set as control group.According to Demeester’s criteria,the two groups were further divided into two groups:pathological acid reflux positive group(acid reflux+group)and pathological acid reflux negative group(acid reflux-group).Basic data and 24-hour esophageal p H monitoring results of all patients were collected to analyze the characteristics of esophageal reflux in the diabetes mellitus complicated with GERD group and the control group.Collecting patient data including age,gender,BMI(kg/m~2),education level,smoking history,drinking history,hypertension history,TC,TG,HDL-C,LDL-C,FPG,Hb A1C,oral hypoglycemic drugs,insulin,NSAIDs drugs,course of diabetes,diabetic nervous system complications and helicobacter pylori infections needed to be collected in the diabetes mellitus complicated with GERD group.To analyze the related risk factors of pathological acid reflux in patients with diabetes mellitus complicated with GERD.Patients with positive esophageal pathologic acid reflux in the diabetes mellitus complicated with GERD group who were reexamined for24-hour esophageal p H monitoring in hospital six months later were collected to compare the changes of 24-hour esophageal p H monitoring results before and after six months’controlling related risk factors.Results:1.The incidence of esophageal pathological acid reflux in the diabetes mellitus complicated with GERD group was higher than that in the control group(56.3%VS 37.8%),and there were significant differences between these two groups(P<0.05).The results of 24-hour esophageal p H monitoring indicated that there were significant differences between diabetes mellitus complicated with GERD group and the control group,including the total percent time p H<4,episodes p H<4,duration of the longest episode,esophageal clearance and De Meester score(P<0.05).2.Results of comparison between acid reflux+group and acid reflux-group in patients with diabetes mellitus complicated with GERD:There were no significant differences in gender,TC,TG,HDL-C,LDL-C,NSAIDs drugs,oral hypoglycemic drugs,insulin,diabetic nervous system complications,hypertension history and helicobacter pylori infections between the two groups(P>0.05),and there were statistically significant differences in age,BMI,education level,FPG,Hb A1c,duration of diabetes(P<0.05).Logistics regression analysis revealed that age(OR=1.784,95%CI1.159-2.745,P<0.05),BMI(OR=1.845,95%CI 1.188-2.865,P<0.05),education level(OR=2.280,95%CI 1.337-3.888,P<0.05),FPG(OR=1.429,95%CI 1.035-2.185,P<0.05),Hb A1c(OR=1.735,95%CI 1.114-2.703,P<0.05)and duration of diabetes(OR=1.531,95%CI 1.003-2.339,P<0.05)were independent risk factors for esophageal pathological acid reflux in patients with diabetes mellitus complicated with GERD.3.Among the independent risk factors for pathological acid reflux in patients with diabetes mellitus complicated with GERD,only BMI,FPG and Hb A1c were controllable,and Hb A1c is more accurately responsive to blood glucose control,so the study conducted statistical analysis on the 24-hour esophageal p H monitoring results before and after BMI and Hb A1c control of reexamination patients six months later,the results indicated that there were significant differences in the percent time p H<4,number of episodes≥5 minutes,duration of the longest episode,esophageal clearance and De Meester score between before and after BMI and Hb A1c control(P<0.05);There were significant differences in the percent time p H<4,duration of the longest episode and De Meester score between before and after BMI control(P<0.05);There were significant differences in the percent time p H<4,duration of the longest episode and De Meester score between before and after Hb A1c control(P<0.05),In this study,we found that after controlling BMI and Hb A1c,24-hour esophageal p H monitoring results were significantly improved.Conclusion:1.The 24-hour esophageal p H monitoring results of patients with diabetes mellitus complicated with GERD were significantly different from those of patients with simple GERD,Patients with diabetes mellitus complicated with GERD are more prone to esophageal pathological acid reflux than patients with simple GERD;2.Age,BMI,education level,FPG,Hb A1c and duration of diabetes are independent risk factors for esophageal pathological acid reflux in patients with diabetes mellitus complicated with GERD.3.Well control of body weight and blood glucose has positive significance for the treatment of pathological acid reflux in patients with diabetes mellitus complicated with GERD. |
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