Esophageal Pathology Screening in Type 1 Diabetes Patients

Issue: 3/1999

Author: M. Atanassova, A. Protopopova, L. Koeva, I. Kotzev, A. Klisarova*, L. Svrakova**, Medical University-Varna, Department of Endocrinology and Gastroenterology, * Department of Radiology, **Department of Neurology
Motility disorders in the gastrointestinal tract, esophagus in particular, developing against the background of diabetic vegetopathy, are still not well enough clarified. It is the purpose of the work to establish the frequency and character of esophageal pathology in diabetes type 1 (D) patients, and seek for a correlation between ascertaind esophageal pathology and peripheral polyneuropathy, and between esophageal pathology and blood glucose levels. The study covers 27 D patients – 15 with and 12 without signs of polyneuropathy. The diagnostic procedures used include: past history based on standartized questionnaire, fibro-esophago-gastroduodenoscopy, punch and brush biopsy for routine histo- and cytomorphological evaluation + Candida and Helicobacter pylori (HP) screening, dynamic scintigraphy with 99mTc pertechnetate for tracing liquid bolus evacuation, neurological evacuation + electromyography for judging polyneuropathy coexistence. Labs: blood glucose profile, ionogram, HBA1c.

Results: Esophageal pathology is ascertained by endoscopy and biopsy material examination in 20 patients (74%). In 66,6 per cent it is closely related to GERD. Candida albicans esophagitis is diagnosed in 2 instances (7,4%). No evidence of HP infection in esophageal mucosa is found. Scintigraphy is performed in 8 cases, and in 5 (62,5%) it reveals prolonged esophageal transport function. In the polyneuropathy group esophageal pathology is diagnosed in 80% vs 66% in the group free of polyneuropathy. Esophagitis grade ll-IV is noted in 3 patients with newly discovered D free of polyneuropathy, and in two with polyneuropathy and D duration < 5 years. In patients with esophageal pathology fasting blood glucose levels amount to 11,5 ± 2 versus 14,9 ± 2,5 postprandial. HBA1c is 10,3 ± 2,1. Twenty-five percent of patients with esophageal pathology are free of symptoms pointing to digestive tract disorders, while 20 percent present such symptoms although atypical.

Conclusions: GERD with or without esophagitis is the commonest esophageal pathology in D type 1; GERD symptoms are equivocal or altogether absent in 25 % of patients. Atypical symptoms, such as chronic cough and noncardiac chest pain, are observed in 10 to 20% of patients. There is no correlation between esophageal pathology, on the one hand, and duration of D type 1 and polyneuropathy symptomatology, on the other. Esophageal pathology in D type 1 correlates strongly with blood glucose control.

Keywords: diabetes, esophageal pathology, GERD, polyneuropathy, blood glucose.


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