The role of autonomic neuropathy as a risk factor of Helicobacter pylori infection in dyspeptic patients with Type 2 diabetes mellitus

A high prevalence of upper gastrointestinal symptoms is described in diabet ic patients and, at least in part, this has been attributed to abnormal emp tying of the stomach. In an unselected small series of dyspeptic patients w ith Type 2 diabetes mellitus (DM2), we previously described a. higher preva lence of Helicobacter pylori (Hp) infection associated with autonomic neuro pathy (AN) than in non-diabetic subjects. To evaluate the prevalence of Hp and its relationship with AN, we studied 164 DM2 patients, matched for sex, age (+/- 5 years) and body weight (+/- kg) to 164 non-diabetic subjects, a ll affected with dyspepsia of unknown origin. Results document that the pre valence of peptic ulcer is similar in both groups of patients (20.1 vs 29.3 %, P = n.s.); chronic gastritis was 50% in the control group and 35.4% in t he DN2 group (P < 0.01) and dyspepsia without ulcer and gastritis (simple d yspepsia) was significantly more frequent in DM2 patients than in non-diabe tics (44.5 vs 20.7%, P < 0.01). Hp infection was documented by histology of gastrointestinal mucosa in 74.4% of the DM2 patients and in 50% of the con trols (P < 0.01) (ulcer: 97 vs 71%, P < 0.05; gastritis: 72 vs 43.5%, P < 0 .05; simple dyspepsia: 66 vs 35%, P < 0.01, respectively). Autonomic neurop athy was found in 65.2% of the DM2 patients (90.9% of patients with ulcer, 65.5% with gastritis and 53.4% with simple dyspepsia). A significant concor dance (84.7%, P < 0.001) was found between the presence of AN and Hp infect ion. Data provide, for the first time, direct evidence for a higher frequen cy of Hp infection in dyspeptic patients affected with DM2 than in non-diab etic subjects. In addition, in diabetic patients the frequency of non-ulcer , non-gastritis dyspepsia is two times higher than in non-diabetics and is strictly associated with autonomic neuropathy, acting as a favoring factor for occurrence and recurrence of gastrointestinal disease. (C) 1998 Elsevie r Science Ireland Ltd. All rights reserved.