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

Abstract

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.