Acid peptic disease in children with type I diabetes mellitus. A complicating relationship
G. A. Burghen, L. R. Murrell, G. L. Whitington, M. K. Klyce and S. Burstein
Department of Pediatrics, University of Tennessee, Memphis 38103.
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.
