The course of peptic gastroduodenal ulcers on the background of comorbid diabetes mellitus

O.V. Syniachenko, M.V. Ermolaeva, N.V. Gmoshinskiy


Background. Comorbid diabetes mellitus (DM) type 2 worsens the course of peptic gastric ulcers (GU) and duodenal ulcer (DU) as well as the effectiveness of therapeutic measures while it is an independent risk factor for the development of gastroduodenal bleeding. Seropositivity of patients with DM as the carriers of Helicobacter infection is 50–60 %, the latter is registered 90 % more often than in the general population. The purpose was to analyze the nature of the course of gastroduodenal ulcers on the background of comorbid DM, to identify prognostic criteria. Materials and me­thods. 1392 patients with GU and DU were under the survey. DM was diagnosed in 215 patients (17 %) who were included in the main group and the remaining (83 %) were in the comparison group. The ratio of DU : GU: GU + DU in the group with DM was 6 : 2 : 1, and among the rest of the patients — 10 : 4 : 1. The ratio of men and women in the first group was 2 : 1, and in the second — 3 : 1, the average age of patients — 52 years, the duration of the manifestation of peptic ulcers — 6 years. The index of the severity of the disease was 6 r.u., level of blood glucose — 10 mmol/l, glycosylated hemoglobin (HbA1c) — 8 %, insulin — 25 µIU/ml, the index of insulin resistance (HOMA) — 12 r.u. The ratio of mild, moderate and severe degree of DM was 1 : 2 : 1. Results. DM is a risk factor for severe course of GU and DU, it determines the localization of ulceration, the size of ulcerations, the development of reflux esophagitis and duodenogastric reflux, the changes in the physico-chemical adsorption-rheological properties of gastric juice and the severity of histological damage to the gastric mucosa which depend on the nature of insulin resistance. Comorbid DM is a risk factor for severe gastroduodenal bleeding, it affects the cardiovascular hemodynamic parameters (the levels of average blood pressure, peripheral vascular resistance, circulating blood volume) and determines 60-hour survival of patients, and predictive criteria include the levels of glycemia, HbA1c and НОМА. Conclusions. Comorbid DM significantly worsens the course of peptic gastroduodenal ulcers and it is a risk factor for their recurrence.


peptic gastroduodenal ulcers; course; diabetes mellitus


Lin HY, Weng SF, Lin HJ, et al. Peptic ulcer disease in healthcare workers: a nationwide population-based cohort study. PLoS One. 2015 Aug 24;10(8):e0135456. doi: 10.1371/journal.pone.0135456.

Komar OM, Kizlova NM, Trylevych OD, Kravchenko VV. Risk factors for adverse course of gastric and duodenal peptic ulcer. Wiad Lek. 2018;71(1 pt 2):160-164.

Park S, Park SY, Kim YJ, et al. Effects of rebamipide on gastrointestinal symptoms in patients with type 2 diabetes mellitus. Diabetes Metab J. 2016 Jun;40(3):240-7. doi: 10.4093/dmj.2016.40.3.240.

Chen YC, Ho CC, Yi CH, Liu XZ, Cheng TT, Lam CF. Exendin-4, a glucagon-like peptide-1 analogue accelerates healing of chronic gastric ulcer in diabetic rats. PLoS One. 2017 Nov 2;12(11):e0187434. doi: 10.1371/journal.pone.0187434.

Chi TY, Zhu HM, Zhang M. Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing. Medicine (Baltimore). 2018 May;97(18):e0665. doi: 10.1097/MD.0000000000010665.

Yu H, Dai XJ, Zhang HB, et al. Efficacy of two bariatric surgeries in type 2 diabetic patients with a body mass index of 25-27.5. Nan Fang Yi Ke Da Xue Xue Bao. 2017 May 20;37(5):693-697. (in Chinese).

Tachecí I, Bures J. Peptic ulcer disease in patients with diabetes mellitus. Vnitr Lek. 2011 Apr;57(4):347-50. (in Czech).

Peng YL, Leu HB, Luo JC, et al. Diabetes is an independent risk factor for peptic ulcer bleeding: a nationwide population-based cohort study. J Gastroenterol Hepatol. 2013 Aug;28(8):1295-9. doi: 10.1111/jgh.12190.

Wu SC, Chen WT, Fang CW, Muo CH, Sung FC, Hsu CY. Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in pepticulcer patients: An Asian population cohort study. Medicine (Baltimore). 2016 Dec;95(49):e5489. doi: 10.1097/MD.0000000000005489.

Wei F, Lin X. Diabetes increases morbidity and mortality rates in peptic ulcer bleeding: An updated systematic review and meta-analysis. Turk J Gastroenterol. 2016 Jul;27(4):304-11. doi: 10.5152/tjg.2016.15448.

Elwakil R, Reda MA, Abdelhakam SM, Ghoraba DM, Ibrahim WA. Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital. J Egypt Soc Parasitol. 2011 Aug;41(2):455-67.

Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Fujino Y, Kubo T. The influence of diabetes mellitus on short-term outcomes of patients with bleeding pepticulcers. Yonsei Med J. 2012 Jul 1;53(4):701-7. doi: 10.3349/ymj.2012.53.4.701.

Magierowski M, Jasnos K, Brzozowska I, et al. Melatonin as a therapeutic factor in gastric ulcer healing under experimental diabetes. Przegl Lek. 2013;70(11):942-6. (in Polish).

Zayachkivska O, Pshyk-Titko I, Hrycevych N, Savytska M. New insight into oseophageal injury and protection in physiologically relevant animal models. J Physiol Pharmacol. 2014 Apr;65(2):295-307.

Nie Z, Xu L, Li C, Tian T, Xie P, Chen X, Li B. Association of endothelial progenitor cells and peptic ulcer treatment in patients with type 2 diabetes mellitus. Exp Ther Med. 2016 May;11(5):1581-1586. doi: 10.3892/etm.2016.3114.

Fouad AA, Al-Sultan AI, Yacoubi MT, Gomaa W. Ameliorative effects of telmisartan in diabetic rats with indomethacin-induced gastric ulceration. Eur J Pharmacol. 2010 Jul 10;637(1-3):162-70. doi: 10.1016/j.ejphar.2010.04.007.

Som S, Dutta Banik G, Maity A, Ghosh C, Chaudhuri S, Pradhan M. Non-invasive diagnosis of type 2 diabetes in Helicobacter pylori infected patients using isotope-specific infrared absorption measurements. Isotopes Environ Health Stud. 2018 Aug;54(4):435-445. doi: 10.1080/10256016.2018.1467414.

Tseng CH. Metformin and Helicobacter pylori infection in patients with type 2 diabetes. Diabetes Care. 2018 Apr;41(4):e42-e43. doi: 10.2337/dc17-2551.

Zhou M, Liu J, Qi Y, et al. The association between Helicobacter pylori seropositivity and risk of new-onset diabetes: a prospective cohort study. Diabetologia. 2018 Feb;61(2):300-307. doi: 10.1007/s00125-017-4465-2.

Mortazavi E, Eslami B, Aghahosseini P, et al. Association of mannose-binding lectin rs1800450 and tumor necrotic factor-α rs1800620 polymorphism with Helicobacter pylori in type II diabetes mellitus. Monoclon Antib Immunodiagn Immunother. 2017 Oct;36(5):236-241. doi: 10.1089/mab.2017.0039.

Copyright (c) 2019 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2019


   Seo анализ сайта