Sibel YENİOCAK, Zeliha HEKİMSOY, Zafer BUYRAÇ, Neşe EKİNCİ, Gazi YÖRÜK, Kadir AKSÖZ, Belkıs ÜNSAL

Tip II Diabetes Mellituslu hastalarda Helicobacter pylori prevalansı

Giriş ve amaç: Hp dünyada en sık rastlanan ve enfekte olgularda antrum ağırlıklı kronik gastrite neden olan bakteriyel bir etkendir. DM artmış enfeksiyon riskiyle karakterize metabolik bir hastalıktır. Bu nedenle çalışmada DM'lu hastalarda Hp prevalansını, bu hastaların metabolik durumu ve diabetin komplikasyonları ile ilişkisinin araştırılması amaçlandı. Gereç ve yöntem: Çalışmaya dispeptik yakınmaları olan, tip 2 DM'lu 40 hasta, kontrol grubuna ise non-diabetik, dispeptik yakınmaları olan sağlıklı 28 olgu dahil edildi. Hastalar DM komplikasyonu ve metabolik kontrol yönünden değerlendirildi. Her iki gruba da üst gastrointestinal sistem endoskopisi uygulandı. Hp'nin histopatolojik tanısı ve patolojik inceleme yönünden mide korpus ve antrumundan 2'şer adet biyopsi alındı. Bulgular: Yaş ve cins açısından DM'lu ve kontrol grubu arasında istatistiksel olarak anlamlı bir fark yoktu. Hp varlığı ile tip 2 DM, metabolik parametreler, glisemik kontrol, DM'un süresi ve komplikasyonları arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Endoskopik ve histopatolojik olarak antral gastrit ve kronik aktif gastrit görülme sıklığı DM grubunda anlamlı olarak yüksek bulunurken, kontrol grubunda eroziv duodenit anlamlı olarak fazla saptandı. Sonuç: Elde ettiğimiz bulgular Hp enfeksiyonu ile Tip 2 DM arasında bir bağlantıyı desteklememektedir. Bununla birlikte, guruplar arasında gastritin tipleri açısından anlamlı fark saptanması, diabetik hastalarda gastritin değişik tipleri ve Hp prevalansı ile ilgili yeni çalışmaların gerekli olduğunu düşündürmektedir.

Anahtar Kelimeler:

Diabetes Mellitus, Helicobacter pylori

The prevalance of Helicobacter pylori in Type II Diabetes Mellitus patients

Background/aim: Helicobacter pylori is the most common seen infectious agent in the world and causes life-long chronic gastritis, predominantly antral, in all carriers without exception. Diabetes mellitus is a disease characterized by a high risk for infections. Therefore, in this study we aimed to evaluate the prevalence of Helicobacter pylori in patients with diabetes mellitus, the metabolic status of these patients and the relation to the complications of diabetes. Materials and methods: Forty type 2 diabetes mellitus patients followed between August 2001- February 2002 by the Endocrinology Outpatient Clinic in Ataturk Training and Research Hospital, Izmir were included into the study. Twenty-eight non-diabetic patients with dyspeptic complaints served as the control group. Patients were evaluated with regard to diabetes mellitus complications and metabolic control. Upper gastrointestinal tract endoscopy was performed in both groups. For the histopathologic diagnosis and pathologic investigation of Helicobacter pylori, biopsies were taken from corpus and antrum. Results: There were no significant differences between the two groups concerning age and gender. No significant relation was found between Helicobacter pylori and type 2 diabetes mellitus, metabolic parameters, glycemic control duration and complications. Antral gastritis and chronic active gastritis were found to be significantly more frequent in the diabetes mellitus group, both endoscopically and histopathologically, and erosive duodenitis was found to be significantly more frequent in the control group. Conclusion: Our results do not support a relation between Helicobacter pylori and type 2 diabetes mellitus. However, the significant difference between the types of gastritis seen in the two groups suggests the need for further researches on gastritis in diabetic patients and Helicobacter pylori prevalence.

Keywords:

Diabetes Mellitus, Helicobacter pylori,

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Foster W. Diabetes Mellitus; Ed: Isselbacher KJ, Braunwald E, Wil- son JD, Martin JB, Favci AS, Kasper DL. Principles of Internal Me- dicine Harrison’s Vol. 2 14thEdition 1998, 334: 2060.
Koloğlu S. Diabetes Mellitus Patogenezi; Ed: Koloğlu S. Endokri- noloji ve Temel Klinik Medikal Network Ltd. Şti. 1996, 613: 367-68.
Bağrıaçık N. Diabetes Mellitus Tanım, Tarihçesi. İ.Ü Cerrahpaşa Tıp Fakültesi Yayınları. 1997: 9.
Damcı T. Özer Z. Aktüel Tıp Dergisi Mart 97 Cilt 2 Sayı 1 sayfa 48-51.
Becker JM: Motilitiy Disorders of the Gastrointestival Tract, Sung Clin North Ame. 1993; 73 (6).
Low PA, Walsch HC, Huang CY, et al. The sympatetic nervous sys- tem in diabetic neuropathy. A clinical and pathologic study brain 1975: 98: 341-356.
Sivri B. H. Pylori Ed: Gürler İliçin. Kadir Biberoğlu, Serhat Ünal, Sema Akalın, Gültekin Süleymanlar 1996 Güneş Kitabevi Temel İç. Has. 2233-236.
Özen, A, H. Pylori, Ed.: Özden A, Şahin B, Yılmaz U, Soykan İ, 2002, Türk Gastroenteroloji Vakfı, Gastroenteroloji, 113-126.
Mark Woodward, Caroline Morrison, Kenneth Mc Coll. An investi- gation into factors associated with Helicobacter pylori infection. Jo- urnal of Clinical Epidemiology 53 (2000) 175-181.
E. De Koster, I DeBruyne. P. Langlet M. Deltenre Evidence based medicine and extradigestive manifestatoins of helicobacter pylori, Acta Gastro-Enterologica Belqica Vol. LXIII, October-December 2000.
Simon L, Tornoczky J, Toth M, et al. The significance of campylo- bacter pylori infection in gastroenterologic and diabetic practice. Orvosi Hetilap. 1989; 130: 1325-9.
Oldenburg B, Diepersloot RJ, Hoekstra JB. High seroprevalance of Helicobacter pylori in diabetes mellitus patients. Dig Dis. Sci. 1996; 41: 458-61.
Gentile S, Turco S oliviero B, et al. The role of autonomic neuro- pathy as a risk factor of Helicobacter pylori infection in dyspeptic patients with Type 2 diabetes mellitus. Diab. Res Clin Pract 1998; 42: 41-8.
Yenigün, Mustafa, Diabetes Mellitus ve Gastrointestinal Sistem. Her Yönüyle Diabetes Mellitus Nobel Tıp Kitabevleri 2001. 467-474.
Harry Hua-Xiang Xia: Ph. D, M. Med, Nicholas J. Talley et al. He- licobacter pylori infection is not associated with Diabetes Mellitus, Nor with upper Gastrointestinal Symptoms in Diabetes Mellitus. The American Journal of Gastroenterology 2001.
Güvener N, Akcan Y, Paksoy I, et al. Helicobacter pylori associated gastric pathology in patients with type 2 DM and its relationship with gastric emptying: The Ankara Study. Exp-Clin Endocrinol Di- ab 1999; 107: 172-6.
Gasbarrini A, Ojetti V, Pitacco D, et al. Helicobacter Pylori infec- tion in patients affected by insulin-dependent diabetes mellitus Eur J. Gastroenterol Hepatol 1998; 10: 469-72.
De Luis DA, De la Calle H, Roy G, et al. Helicobacter Pylori infec- tion and insülin-dependent diabetes mellitus. Diab Res Clin Pract 1998; 39: 143-6.
Mallecki M, Blen AI, Galicka-Latalla D, et al. The prevalance of Helicobacter pylori infection and types of gastritis in diabetic pati- ents: The Krakov study. Exp. Clin. Endocrinol Diab 1996; 104: 365- 9.
Salardi S. Cacciari E. Menegatti M. et al. Helicobacter pylori and type 1 diabettes mellitus in children .J. Pediatr Gastoenterol Nutr 1999: 28: 307-9.
Persico M, Suozza R, De seta M. Et al non-ulcer dyspepsia and He- licobacter pylori in type 2 diabetic patients: Association with auto- nomic neuropathy. Diab Res Clin Pract 1996; 31: 87-92.
Kao CH, Pan DY, Wang SJ, et al. The relationship between Helico- bacter pylori infection and gastric emptying in patients with non- in- sülin-dependent diabetes mellitus. Eur J. Nutr. Med. 1995; 22: 122- 5.
Xia HH-X, Kalantar JS, Mitchell HM, et al. Can Helicobacter pylo- ri serology still be a surrogate marker to identify peptic ulcer dise- ase in dyspepsia: Aliment Pharmacol Ther 2000; 14: 615-24.
Xia H-X, Talley Nj. Matural acquisition and Spontoneous eliminati- on of Helicobacter Pylori infection. Am J. Gastroenterol 1997; 92: 1780-7.
Dore MP, Bilotta M, Malaty Hm, et al. Diabetes mellitus and H. pylori infection Nutrition 2000 Jun; 16 (6) 407-10.