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. 2018 Mar 15;13(3):e0194466.
doi: 10.1371/journal.pone.0194466. eCollection 2018.

Decline in perception of acid regurgitation symptoms from gastroesophageal reflux disease in diabetes mellitus patients

Kosuke Sakitani  1 , Nobumi Suzuki  1 , Sozaburo Ihara  1 , Yoshihiro Hirata  2 , Shoji Kawazu  1 , Yasuhiko Iwamoto  1 , Kazuhiko Koike  2
Affiliations

Decline in perception of acid regurgitation symptoms from gastroesophageal reflux disease in diabetes mellitus patients

Kosuke Sakitani et al. PLoS One. .

Abstract

Objectives: To determine if a discrepancy exists between subjective symptoms and the grade of endoscopic gastroesophageal reflux disease (GERD) in diabetes mellitus (DM) patients.

Methods: All 2,884 patients who underwent esophagogastroduodenoscopy completed the modified Gastrointestinal Symptom Rating Scale (GSRS), an interview-based rating scale consisting of 16 items including a question on acid regurgitation. Patients were divided into DM and non-DM groups (1,135 and 1,749 patients, respectively). GERD was diagnosed endoscopically and graded according to the Los Angeles classification. Grade B or more severe GERD was defined as severe endoscopic GERD. The intergroup GSRS score was compared statistically.

Results: In severe endoscopic GERD patients, the prevalence of patients with a positive GSRS score in the acid regurgitation question was statistically lower in DM patients than non-DM patients. Of the 60 non-DM patients with severe endoscopic GERD, 40 patients (67%) had a positive GSRS score for acid regurgitation; however, of the 51 DM patients with severe endoscopic GERD, 23 patients (45%) had a positive GSRS score. Multivariate analysis showed that severe endoscopic GERD (OR: 2.01; 95% CI: 1.21-3.33; p = 0.0066), non-DM (OR: 0.74; 95% CI: 0.54-0.94; p = 0.0157), younger age (OR: 0.98; 95% CI: 0.97-0.99; p = 0.0125), and hiatal hernia (OR: 1.46; 95% CI: 1.12-1.90; p = 0.0042) were associated with acid regurgitation symptoms.

Conclusions: There is a discrepancy between subjective symptoms and endoscopic GERD grade in DM patients. The ability of DM patients to feel acid regurgitation may be decreased.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Percentage of positive GSRS scores (≥ 2) for items 1–9 in severe endoscopic GERD patients.
The percentage of patients with GSRS scores ≥ 2 for items 1–9 in non-DM (n = 60) and DM (n = 51) patients with severe endoscopic GERD are shown.
See this image and copyright information in PMC

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