STUDY OF GASTRO-ESOPHAGEAL REFLUX IN TYEP-I DIABETES MELLITUS
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The aim of this work is to study the prevalence of abnormal gastro-esophageal (GE) reflux in type-I diabetes mellitus without esophageal symptoms and the link between the presence of the cardiovascular autonomic neuropathy (CVAN) and the development of abnormal GE reflux. This study was carried out on 82 subjects (48 males & 34 females) with type-1 diabetes mellitus (study group). They were selected from those admitted at the Internal Medicine Department of Benha University Hospitals. Their ages ranged from 15-48 years (with a mean age of 31 ± 8.1). The study group was matched against 60 healthy subjects (36 males & 24 females), served as a control group, regarding age, sex, and body mass index. Based on the cardio-vascular autonomic reflexes, the study group was classified into 33 diabetics (19 thales and 14 females) with CVAN (group A) and 49 diabetics (29 males and 20 females) without CVAN. The mean levels of 24-hours ambulatory esophageal pH monitoring tests (percentage of total time, post-prandial time and recumbent time at a pH <4) in the study group were significantly higher than the control group (P<0.001 respectively). Also, the mean levels of 24 hours ambulatory esophageal pH monitoring of the previous parameters in group A were significantly higher than in group B (P<0.001 respectively). The abnormal GE reflux was detected in 24 diabetic patients (16 patients in-group A & S patients in group l3). and there was a statistical significant difference between the two (I, „ ; ig the 1,:‘,er csophaucal sphincter (LES) pressure, there was •igniticant Wrierence in the mean levels of the basal pressure between the study and the control group (P-.0.05) and in between the diabetic groups A & B (P>0.05). Also, no association was found •between abnormal GE reflux and LES pressure (P>0.05). It is concluded from this study that the abnormal GE reflux was found in a high degree of frequency (29.3 %) in asymptomatic diabetic patients (48.5% in group A & 16.3% in group B). This abnormal GE reflux was associated with diabetic CVAN. Early ' treatment and strict control of type-1 diabetes mellitus is highly recommended in diabetics without esophageal symptoms to delay the onset of CVAN and consequently the abnormal GE reflux Also, this study throw spot lights on the importance of 24-hour ambulatory esophageal pH monitoring, which is the most useful technique. for this purpose, in early detection of abnormal GE reflux in diabetic patients.