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Acid peptic disease in children with type I diabetes mellitus. A complicating relationship
G A Burghen1, L R Murrell, G L Whitington
1Department of Pediatrics, University of Tennessee, Memphis 38103.
Insights
Acid peptic disease affects 7% of pediatric patients with insulin-dependent diabetes mellitus, complicating treatment and growth. Early diagnosis and therapy improve diabetes management and reduce hospitalizations.
Area of Science:
- Gastroenterology
- Endocrinology
- Pediatrics
Background:
- Acid peptic disease (APD) is a potential complication in pediatric patients with insulin-dependent diabetes mellitus (IDDM).
- The impact of APD on the management and outcomes of IDDM in children is not well understood.
Purpose of the Study:
- To determine the prevalence of APD in pediatric patients with IDDM.
- To investigate the effects of APD on the treatment and control of IDDM.
Main Methods:
- A matched case-control study involving 31 pediatric patients with IDDM and APD symptoms, and 31 controls with IDDM.
- Data collected through patient/parent interviews, chart reviews, and endoscopy.
- Measurements included glycosylated hemoglobin, stature, hospital admission frequency, and parental history of APD.
Main Results:
- APD prevalence was 7% in the pediatric IDDM population.
- Endoscopic findings revealed gastritis (94%), bile staining (58%), and bile pooling (52%).
- Patients with APD had shorter stature, more hospital admissions, and a higher prevalence of parental APD. Therapy reduced diabetes-related hospital admissions by 50%.
Conclusions:
- APD is an underrecognized factor complicating IDDM treatment in children.
- Clinical suspicion is crucial for managing compromised diabetes control, treatment compliance, and growth expectations.
Objective:
To determine the prevalence of acid peptic disease among pediatric patients with insulin-dependent diabetes mellitus and to study the effects of acid peptic disease on treatment of insulin-dependent diabetes mellitus.
Design:
Inception cohort and matched case-control study, with a data set derived from patient and parent interviews and inpatient and outpatient chart reviews.
Setting:
LeBonheur Children's Medical Center, a university-affiliated hospital in Memphis, Tenn.
Participants:
Thirty-one patients with insulin-dependent diabetes mellitus who presented with multiple episodes of symptoms of acid peptic disease were examined by endoscopy. Thirty-one control patients with insulin-dependent diabetes mellitus and transient or no gastrointestinal complaints were matched for age, gender, race, and duration of diabetes.
Measurements:
Glycosylated hemoglobin levels, stature, frequency of hospital admissions, and parental history of acid peptic disease.
Results:
Acid peptic disease occurred with a prevalence of 7% in our population of pediatric patients with insulin-dependent diabetes mellitus. Major endoscopic findings included gastritis confirmed by upper gastrointestinal biopsy (94%), bile staining of gastric mucosa (58%), and bile pooling (52%). Patients with acid peptic disease demonstrated shorter stature, greater frequency of hospital admissions, and greater prevalence of parental acid peptic disease by history than those of controls. In the 18 months following acid peptic disease therapy, hospital admissions for diabetes-related problems decreased by 50%.
Conclusions:
Acid peptic disease is an underrecognized complicating factor in the treatment of diabetes. Clinical suspicion is necessary to offset compromised diabetes control, compliance to treatment regimens, and/or growth expectations associated with this disease.