The Relationship Between Type 2 Diabetes Mellitus and Refractory Gastroesophageal Reflux Disease

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Purpose: The prevalence of both type 2 diabetes mellitus (DM) and gastroesophageal reflux disease (GERD) have increased in the last few decades. There has been limited information regarding the contribution of type 2 DM to proton pump inhibitor (PPI) failure in GERD patients. The aims of this study were to determine if type 2 DM is a risk factor for PPI failure in GERD patients and to define potential predictive factors for PPI failure among type 2 DM GERD patients. Methods: By using hospital medical records, GERD patients who are currently treated with a PPI were identified. PPI failure was considered if patients utilized more than once daily PPI or added another medical anti-reflux therapy to PPI once daily due to persistent GERD symptoms. The prevalence of type 2 DM and other risk factors (established at least 1 year before study enrollment) was compared between a PPI failure and a PPI responder group. Logistic regression was performed in order to study the potential association between PPI failure and the presence of type 2 DM. Univariate and multivariate logistic regression analysis were also performed to determine predictors for PPI failure in diabetic patients with GERD. Results: A total of 732 GERD patients receiving PPI therapy, 285 with PPI failure, were included. The prevalence of PPI failure was significantly higher in diabetic versus non-diabetic patients (42.9% vs. 35.2%, OR = 1.38, 95% CI 1.02-1.86). Obesity modulated the relationship between PPI failure and type 2 DM. In obese patients, the odds ratio of PPI failure was significantly higher in type 2 DM as compared with non-DM patients (OR = 1.71; 95% CI 1.1-2.67). In the subgroup of GERD patients with type 2 DM (n = 349), PPI failure was significantly associated with female sex (OR = 10.6; 95% CI 1.94-98.8) and the presence of general co-morbidities (OR = 2.07; 95% CI 1.09- 3.98). Adequate DM control significantly reduced the risk of PPI failure (OR = 0.61; 95% CI 0.4- 0.94). Duration of type 2 DM, the type of antidiabetic medication prescribed and DM-related complications were not associated with PPI failure. Conclusion: PPI failure was significantly associated with type 2 DM and this relationship was modulated by obesity. Among GERD patients with type 2 DM, failure of PPI treatment was significantly associated with female sex and the presence of general co-morbidities. Adequate DM control reduced the risk of PPI failure.

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