NEVZAT GÖZEL, Fatih DEMİRCAN, FARUK KILINÇ, Banu ŞENATEŞ ERKALMA

Gastroözofageal reflü hastalığının diyabetes mellituslu hastalardaki sıklığı ve yaşam kalitesi üzerindeki etkisi

Giriş ve Amaç: Gastroözofageal reflü hastalığının diyabetes mellituslu hastalardaki sıklığı ve gastroözofageal reflü hastalığının diyabetli hasta- ların yaşam kalitesi üzerindeki etkisini araştırmak. Gereç ve Yöntem: Çalışmaya İç Hastalıkları Polikliniğimize başvuran yaşları 16 ile 85 arasın- da olan, 170 Tip 2 ve 30 Tip 1 diyabet olmak üzere toplam 200 diyabet hastası alındı. Hastalara, Belafsky ve ark. tarafından düzenlenen reflü semptom anketi yüz yüze uygulandı. Pirozis ve regürjitasyonun sıklığı, şiddeti, tolerabilitesi, uyku üzerine etkisi, sigara, alkol, ilaç kullanımı, çay ve kahve içimi gibi parametreler sorgulandı. Bulgular: Hastaların yaş ortalaması 53±15 olarak bulundu. Hastaların %62,5i kadın, %37,5i erkekti. Hastaların hepsi diyabetes mellitus için çoklu tedavi kullanıyordu ve 142 hastanın (%71) tedavisi metformin içeriyordu. Pirozis; hastaların %11inde sıklıkla gözlenirken, regürjitasyon %7sinde sıklıkla gözlenmiştir. Hastaların ortalama vücut kitle indeksleri 27,7±4,2 olarak bulundu. Tip 2 diyabetli hastalarda pirozis ve regürjitasyon daha sık olarak bu- lundu. Obez (vücut kitle indeksi≥30) olan hastaların semptomları, obez olmayanlara göre daha sık ve şiddetli idi. Fakat vücut kitle indeksi ile reflü semptomları arasındaki ilişki anlamlı değil idi (regürjitasyon için; r=0,07, p=0,303, pirozis için r=0,08, p=0,15). Hem pirozis (p=0,003), hem de regürjitasyon (p=0,017), kadınlarda erkeklerden daha sıktı ve daha uzun zamandır mevcuttu (sırasıyla p

The prevalence of gastroesophageal reflux disease and its affect on quality of life in diabetes mellitus patients

Background and Aims: The aim of our study was to investigate the incidence of gastroesophageal reflux disease symptoms in patients with diabetes mellitus and to assess its effect on quality of life. Materials and Methods: The study included 200 patients (170 type 2 and 30 type 1 diabetes patients) between 16 and 85 years of age who were admitted to our internal medicine polyclinic. A reflux symptom ques- tionnaire, developed by Belafsky et al., was administered to patients face-to-face. Heartburn and regurgitation frequency, intensity, toler- ability, effects on sleep, smoking, alcohol, drug use, tea and coffee drink were included. Results: Mean patient age was 53 (±15). 62.5% were female and 37.5% were male. All patients were treated with multidrugs for diabetes mellitus and 142 patients (71%) were treated using metformin therapy. Heartburn and reguritation were frequently observed in 11% and 7% of patients, respectively. The mean body mass index was 27.7±4.2. Type 2 diabetic patients had more frequent heart- burn and regurgitation. Obese (body mass index ≥ 30) patients had more frequent and severe symptoms than non-obese patients. Howev- er, the relationship between body mass index and reflux symptoms was not significant (regurgitation r=0.07, p=0.303, r=0.08 for heartburn, p= .15). Both heartburn (p=0.003) and regurgitation (p=0.017) were more common in females than males, and was prolonged (p <0.001 and p=0.004) and more severe (p=0.0009 and p=0,006) Conclusion: In conclusion, gastroesophageal reflux disease occurs frequently in diabetes mellitus patients. Diagnosis and treatment of these patients are important because it negatively affects quality of life. We studied gastroesophageal reflux disease in patients with diabetes and noted that type 2 diabetes mellitus female patients showed an increased severity in duration of symptoms.

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1. Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gas- troesophageal reflux disease on health-related quality of life. Am J Med 1998;104:252-8.
2. Wahlqvist P. Symptoms of gastroesophageal reflux disease, per- ceived productivity, and health-related quality of life. Am J Gastro- enterol 2001;96:S57-61.
3. Bytzer P, Talley NJ, Hammer J, et al. GI symptoms in diabetes mel- litus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol 2002;97:604-11.
4. Camilleri M. Advances in diabetic gastroparesis. Rev Gastroenterol Disord 2002;2:47-56.
5. Bytzer P, Talley NJ, Leemon M, et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001;161:1989-96.
6. Kase H, Hattori Y, Sato N, Banba N, Kasai K. Symptoms of gas- troesophageal reflux in diabetes patients. Diabetes Res Clin Pract 2008;79:e6-7.
7. Richter JE. Gastroesophageal reflux disease. In: Management of gastrointestinal disease. Ed. SJ Winaver, Gower Med Pub. New York, l992;1-42.
8. Richter JE. Typical and atypical presentation of gastroesophgeal reflux disease. Gastroenterol Clin North Am 1996;25:75-102.
9. Traube M. The spectrum of the symptoms and presentations of gastroesophageal reflux disease.Gastroenterol Clin North Am 1990;19:609-16.
10. Belafsky PC, Postma GN, Koufman KA. Validity and reliability of the reflux symptom index (RSI). J Voice 2002;16:274-7.
11. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastrooesophageal reflux disease: a systematic review. Gut 2005;54:710-7.
12. Mungan Z, Demir K, Onuk MD, et al. Characteristics of gastro- esophageal reflux disease in our country Turk J Gastroenterol 1999;10:101-6.
13. Bor S, Mandiracioglu A, Kitapcioglu G, et al. Gastroesophageal re- flux disease in a low-income region in Turkey. Am J Gastroenterol 2005;100:759-65.
14. Sun XM, Tan JC, Zhu Y, Lin L. Association between diabetes melli- tus and gastroesophageal reflux disease: A meta-analysis. World J Gastroenterol 2015;21:3085-92.
15. Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesoph- ageal reflux: incidence and precipitating factors. Am J Dig Dis 1976;21:953-6.
16. Nilsson M, Lundegardh G, Carling L, et al. Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gas- troenterol 2002;37:626-30.
17. Nilsson M, Johnsen R, Ye W, et al. Obesity and estrogen as risk fac- tors for gastroesophageal reflux symptoms. JAMA 2003;290:66- 72.
18. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an inde- pendent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 2005;100:1243-50.
19. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005;143:199-211.
20. Oğuz A, Temizhan A, Abacı A, et al. Obesity and abdominal obesi- ty; an alarming challenge for cardio-metabolic risk in Turkish adults. Anadolu Kardiyol Derg 2008;8:401-6.
21. Onat A, Örnek E, Şenocak M, et al. Türkiyede erişkinlerde kalp hastalığı ve risk faktörleri sıklığı taraması: 6. Diabet ve obezite to- plantısı. Türk Kardiyol Dern Arş 1991;19:178-85.
22. Jacobson BC, Somers SC, Fuchs CS, et al. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 2006;354:2340-8.