H. pylori and gastropathy in diabetes

Анотація

Over the last 11 years the prevalence of diabetes in Ukraine has increased rapidly – from 1.8 to 2.8%. This especially concerns children and adolescents. The progression and compensation of the diabetes depend on many factors. In today’s medical literature the role of Helicobacter рylori in the development and progression of diabetic gastroparesis is widely discussed. In addition, the issue of the necessity and feasibility of H. Pylori eradication in these patients is also keenly discussed. The results are rather contradictory. The results of infection of H. рylori, the peculiarities of progression, the impact on the compensation of H. рylori in patients with diabetes of I and II type are provided in this article.
Materials and methods. The study included 52 patients with diabetes in which the erythematous and erosive gastropathy were found during fibrogastroduodenoscopy. The diagnosis of diabetes was set according to the criteria of the American Diabetes Association, year 2010. The patients were treated at the gastroenterology and endocrinology department of the A. Novak Uzhhorod Regional Clinical Hospital. Glycated hemoglobin (HbA1c) was measured in all of the patients. H. рylori was measured by a quick test for determining the Helicobacter pylori antigen in the stool using the test system Cer Test Diotec Sl., Spain.
Results and discussion. 65% of the women and 35% of the men were studied. The group with type I diabetes comprised of 76% women and 24% men, andwith type II diabetes – 44% women and 56% men. The age of the patients with type I diabetes – 44.5±3.79 years, type II diabetes - 51±3.86. The study of the patients with type I diabetes has shown the presence of helicobacter infection in 35% of the patients. In patients with type II diabetes the presence of H. рylori antigen in stool was found in 77% of the patients. In patients with type I diabetes infected with H. рylori (first group) asthenoneurotic syndrome prevailed in the clinical progression: general weakness in 83% of the infected with H. рylori, and in 91% H. рylori in not infected patients with type I diabetes. Weight loss was registered in 67% of the first group and in 36% of the second group, dyspeptic syndrome: nausea in 71% (not infected – 50%), vomiting – 43% (25%), heartburn – 57% (0%), constipation – 43% (50%), diarrhea – 21% (25%). Dry mouth was registered in 67% of the patients with type I diabetes infected with H. рylori, and in 91% of not infected. Polydipsia was registered correspondingly: in 52% of the patients from group I, and in 82 % of the patients from group II. In patients with type II diabetes infected with H. рylori (third group) the dyspeptic syndrome prevailed in the clinical progression: nausea in 78% (not infected – 50%). Vomiting – 57% (21%), heartburn – 71% (25%), constipation – 43% (50%), diarrhea – 28% (25%). Dry mouth was registered in 71% of the patients with type II diabetes infected with H. рylori, and in 100% of not infected with H. рylori (fourth group). Polydipsia was registered correspondingly in 50% of the patients from the third group and in 75% of the patients from the fourth group. During the treatment the compensation of type I diabetes infected with H. рylori was registered in 42% of the patients, and not infected with H. рylori – 84% of the patients before the end of the first week of treatment. In type II diabetes with helicobacteriosis the compensation of the diabetes occurred in 29% of the patients before the end of the week. In patients with type II diabetes without helicobacteriosis the compensation was registered in 75% of the patients.
Conclusions. 1. Helicobacteriosis was registered in 35% of the patients with type I diabetes, and in 77% of the patients with type II diabetes. 2. In patients with type I and type II diabetes infected with H. рylori nausea, heartburn, vomiting, general weakness and weight loss are observed more often in the clinical progression. 3. The presence of the helicobacter infection in patients with type I and type II diabetes has a negative effect of the terms of diabetes compensation on the background of treatment. 4. Taking into account the relatively high incidence of helicobacter infection in patients with diabetes it is necessary to include the determination of the H. рylori infection for differential diagnostics with diabetic gastropathy.