Gastro-esophageal reflux disease among type-2 diabetes mellitus patients in a rural area
Background: One of the most neglected complications of diabetes mellitus (DM) is gastro-esophageal reflux disease (GERD) which arises from autonomic neuropathy and diabetic gastropathy related to the extent of DM. This study was done to find prevalence of GERD in DM patients with GERD-questionnaire (GERDQ), dietary factor proportion, and their association with other GERD risk factor in rural area.
Methods: This cross sectional study was conducted in Puskesmas Pelaihari from August to September 2013. Subjects with DM aged ≥ 18 were selected consecutively from both newly and previously diagnosed patients with exclusion criteria: pregnancy, in proton-pump inhibitor therapy, and had other metabolic disease(s). DM was diagnosed with ADA criteria, while GERD was diagnosed in patients with score of ≥ 8 of Indonesian GERDQ.
Results: There were 30 subjects (29.7%) with GERD among 101 patients with DM and dietary factors found in GERD patients were spicy diet (90%), high-fat food (90%), irritative beverages (87%), and irritative diet (23%). Only female gender was associated with GERD vs non-GERD in DM patients (87% vs 68%, p = 0.048). Meanwhile, duration of DM (2 [0-13] vs 2 [0-19], p = 0.976), obesity (37% vs 38%, p = 0.897), age (53.2±10.5 vs 54.7 ± 9.3, p = 0.481), and uncontrolled diabetes (90% vs 94%, p = 0.421) were not associated with the GERD among DM patients.
Conclusion: Prevalence of GERD in DM is somewhat high in this study. Female group with DM needs to be screened for GERD as early as possible.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl1):S62-9. http://dx.doi.org/10.2337/dc10-S062
Badan Penelitian dan Pembangunan Kesehatan. Riset kesehatan dasar (Riskesdas) 2007. Jakarta: Departemen Kesehatan Republik Indonesia; 2008. Indonesian.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53. http://dx.doi.org/10.2337/diacare.27.5.1047
Kinekawa F, Kubo F, Matsuda K, Inoue H, Kuriyama S. Gastroesophageal reflux disease in diabetic patients. Nihon Rinsho. 2004;62(8):1546-52. Japanese.
Cao Y, Yan X, Ma XQ, Wang R, Johansson S, Wallander MA, et al. Validation of a survey methodology for gastroesophageal reflux disease in China. BMC Gastroenterology. 2008;8:37. http://dx.doi.org/10.1186/1471-230X-8-37
Aulia C. Prevalence of non-erosive reflux disease in Pondok Indah Hospital: a preliminary study. Acta Med Indones. 2005;37(2):79-81.
Lelosutan SAR, Manan C, Nur BM. The role of gastric acidity and lower esophageal sphincter tone on esophagitis among dyspeptic patients. Indones J Gastroenterol Hepatol Dig Endosc. 2001;2(3):6-11.
Ang TL, Fock KM, Ng TM, Teo EK, Chua TS, Tan J. A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country. World J Gastroenterol. 2005;11(23):3558-61. http://dx.doi.org/10.3748/wjg.v11.i23.3558
Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, et al. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(1):52-7. http://dx.doi.org/10.1111/j.1572-0241.2001.03451.x
Jonasson C, Moum B, Bang C, Andersen KR, Hatlebakk JG. Randomised clinical trial: a comparison between a GerdQ-based algorithm and an endoscopy-based approach for the diagnosis and initial treatment of GERD. Aliment Pharmacol Ther. 2012;35(11):1290-300. http://dx.doi.org/10.1111/j.1365-2036.2012.05092.x
Andrijani PK, Manan C, Simadibrata M, Siregar P. Specific subjective symptoms for gastroesophageal reflux disease in ulcer like dyspepsia. Indones J Gastroenterol Hepatol Dig Endosc. 2004;5(1):7-14.
Frokjaer JB, Andersen SD, Ejskjaer N, Funch-Jensen P, Drewes AM, Gregersen H. Impaired contractility and remodeling of the upper gastrointestinal tract in diabetes mellitus type-1. World J Gastroenterol. 2007;13(36):4881-90.
Kase H, Hattori Y, Sato N, Banba N, Kasai K. Symptoms of gastroesophageal reflux in diabetes patients. Diabetes Res Clin Pract. 2008;79(2):e6-7. http://dx.doi.org/10.1016/j.diabres.2007.08.019
Kinekawa F, Kubo F, Matsuda K, Kobayashi M, Furuta Y, Fujita Y, et al. Esophageal function worsens with long duration of diabetes. J Gastroenterol 2008;43(5):338-44. http://dx.doi.org/10.1007/s00535-008-2169-6
Wang X, Pitchumoni CS, Chandrarana K, Shah N. Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy. World J Gastroenterol. 2008;14(5):709-12. http://dx.doi.org/10.3748/wjg.14.709
Hirata A, Kishida K, Nakatsuji H, Inoue K, Hiuge-Shimizu A, Funahashi T, et al. High prevalence of gastroesophageal reflux symptoms in type 2 diabetics with hypoadiponectinemia and metabolic syndrome. Nutr Metab (Lond). 2012;9(1):4. http://dx.doi.org/10.1186/1743-7075-9-4
Lluch I, Ascaso JF, Mora F, Minguez M, Pe-a A, Hernandez A, et al. Gastroesophageal reflux in diabetes mellitus. Am J Gastroenterol. 1999;94(4):919-24. http://dx.doi.org/10.1111/j.1572-0241.1999.987_j.x
Horikawa A, Ishii-Nozawa R, Ohguro M, Takagi S, Ohtuji M, Yamada M, et al. Prevalence of GORD (gastro-oesophageal reflux disease) in type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD. Diabet Med. 2009;26(3):228-33. http://dx.doi.org/10.1111/j.1464-5491.2009.02671.x
Lee SD, Keum B, Chun HJ, Bak YT. Gastroesophageal reflux disease in type II diabetes mellitus with or without peripheral neuropathy. J Neurogastroenterol Motil. 2011;17(3):274-8. http://dx.doi.org/10.5056/jnm.2011.17.3.274
Maev IV, Iurenev GL, Kakhramanova DA. [Peculiarities of gastroesophageal reflux disease in patients with type 2 diabetes mellitus]. Klin Med (Mosk). 2012;90(9):53-6. Russian.
Hershcovici T, Jha LK, Gadam R, Cui H, Gerson L, Thomson S, et al. The relationship between type 2 diabetes mellitus and failure to proton pump inhibitor treatment in gastroesophageal reflux disease. J Clin Gastroenterol. 2012;46(8):662-8. http://dx.doi.org/10.1097/MCG.0b013e31824e139b
Iyer PG, Borah BJ, Heien HC, Das A, Cooper GS, Chak A. Association of Barrett's esophagus with type II Diabetes Mellitus: results from a large population-based case-control study. Clin Gastroenterol Hepatol. 2013;11(9):1108-14. http://dx.doi.org/10.1016/j.cgh.2013.03.024
World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communication Australia Pty Ltd; 2000.
Simadibrata M, Rani A, Adi P, Djumhana A, Abdullah M. The gastro-esophageal reflux disease questionnaire using Indonesian language: a language validation survey. Med J Indones. 2011;20(2):125-30. http://dx.doi.org/10.13181/mji.v20i2.442
Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol. 2009;44(6):518-34. http://dx.doi.org/10.1007/s00535-009-0047-5
Yamagishi H, Koike T, Ohara S, Kobayashi S, Ariizumi K, Abe Y, et al. Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan. World J Gastroenterol. 2008;14(9):1358-64. http://dx.doi.org/10.3748/wjg.14.1358
Hung LJ, Hsu PI, Yang CY, Wang EM, Lai KH. Prevalence of gastroesophageal reflux disease in a general population in Taiwan. J Gastroenterol Hepatol. 2011;26(7):1164-8. http://dx.doi.org/10.1111/j.1440-1746.2011.06750.x
Mungan Z. Prevalence and demographic determinants of gastroesophageal reflux disease (GERD) in the Turkish general population: a population-based cross-sectional study. Turk J Gastroenterol. 2012;23(4):323-32.
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871-80 http://dx.doi.org/10.1136/gutjnl-2012-304269
Sonnenberg A, El-Serag HB. Clinical epidemiology and natural history of gastroesophageal reflux disease. Yale J Biol Med. 1999;72(2-3):81-92.
Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Prevalence of gastro-oesophageal reflux symptoms and the influence of age and sex. Scand J Gastroenterol. 2004;39(11):1040-5 http://dx.doi.org/10.1080/00365520410003498
Lin M, Gerson LB, Lascar R, Davila M, Triadafilopoulos G. Features of gastroesophageal reflux disease in women. Am J Gastroenterol. 2004;99(8):1442-7. http://dx.doi.org/10.1111/j.1572-0241.2004.04147.x
Yamamichi N, Mochizuki S, Asada-Hirayama I, Mikami-Matsuda R, Shimamoto T, Konno-Shimizu M, et al. Lifestyle factors affecting gastroesophageal reflux disease symptoms: a cross-sectional study of healthy 19864 adults using FSSG scores. BMC Medicine. 2012;10:45. http://dx.doi.org/10.1186/1741-7015-10-45
Promberger R, Lenglinger J, Riedl O, Seebacher G, Eilenberg WH, Ott J, et al. Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and patophysiologic aspects - a retro-pro study. BMC Gastroenterology. 2013;13:132. http://dx.doi.org/10.1186/1471-230X-13-132
Promberger R, Gadenstätter M, Ciovica R, Schwab G, Neumayer G. Gastrooesophageal reflux disease in diabetic patients: a systematic review. Eur Surg. 2007;39(6):340-54. http://dx.doi.org/10.1007/s10353-007-0366-9
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-28. http://dx.doi.org/10.1038/ajg.2012.444
Ishige N. The dietary culture of Asia [Internet]. New York: AsiaSociety. 2008 Sept- [cited 2013 Oct 12]. Available from: http://asiasociety.org/blog/asia/dietary-culture-asia.
El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. 2005;54(1):11-7.
Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965-71. http://dx.doi.org/10.1001/archinte.166.9.965
Talley NJ, Silverstein MD, Agréus L, Nyrén O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. American Gastroenterological n. Gastroenterology. 1998;114(3):582-95. http://dx.doi.org/10.1016/S0016-5085(98)70542-6
Jackson AL, Rashed H, Cardoso S, Wong F, Werkman R, Thompson J, et al. Assessment of gastric electrical activity and autonomic function among diabetic and nondiabetic patients with symptoms of gastroesophageal reflux. Dig Dis Sci. 2000;45(9):1727-30. http://dx.doi.org/10.1023/A:1005542530328
Copyright (c) 2015 Christopher S. Suwita, Benny Benny, Daniel R. Mulyono, Selti Rosani, Yuni Astria, Felix F. Widjaja, Ari F. Syam
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.