Esophageal motility disorders in patients with diabetes mellitus

The prevalence of gastrointestinal symptoms seems to be increased in diabetics compared with general population. The aim of this work is to study the esophageal motor abnormalities in diabetic patients to determine whether esophageal motility disorders are related to the symptoms and the clinical status of the patients. The study was conducted on 120 diabetic patients and 20 healthy control divided into-group I: 20 healthy controls, group II: 60 type I diabetic patients, group III: 60 type 2 diabetic patients. They were monitored by laboratory tests-Fundus examination-Abdominal sonography-upper esophagogastric endoscopy-esophageal manometry including lower esophageal sphincter study, esophageal body study, and upper esophageal sphincter study. The data was collected, statistically analyzed using computer program SPSS version nine. There was significant difference between type I and 2 diabetics compared to controls regarding decrease in lower esophageal resting pressure, decrease in peristalsis wave percent, and decrease in proximal, distal body peristaltic amplitude. None significant difference regarding lower esophageal sphincter relaxation percent, residual pressure, proximal body duration, distal body duration and upper esophageal sphincter resting pressure were detected. There was significant difference regarding decrease in peristaltic wave% non transmitted wave% and proximal body amplitude in type I diabetics compared to type 2. Diabetes per se is a significant risk factor for increased incidence of esophageal motility dysfunction in the form of decreased lower esophageal resting pressure, decreased body peristalsis, increased non-transmitted wave percent. Increased double-peak wave percent decreased proximal and distal body amplitude

Evaluation of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation for eradication of esophageal varices: a prospective randomized controlled study

Bleeding from esophageal varices is the most severe and lethal complication of portal hypertension. The aim of this work was evaluation of the technique of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation as a new method used for eradication of esophageal varices. This study was conducted on 200 patients out of 294 studied patients. Patients who fulfilled the inclusion criteria were randomized to four groups, Group I: comprised of 50 patients who were subjected to endoscopic injection sclerotherapy, Group II. comprised of 50 patients who were subjected to variceal band ligation, Group III comprised of 50 patients who were subjected to combined endoscopic sclerotherapy and band ligation, Group IV comprised of 50 patients who were subjected to endoscopic band ligation plus argon plasma photocoagulation. Comparison of the endoscopic number of therapeutic session between different studied groups showed that group III was significantly lower in number of sessions. As regard post treatment complications during the follow up period, Group I showed the high incidence of transient pyrexia, transient dysphagia and/or retrosternal pain and ulceration, while group II showed the higher incidence of re-bleeding was demonstrated. The higher incidence of recurrence rate of esophageal varices after eradication during the follow up was detected in group II, while the higher mortality incidence was detected in group I and II, In this study the follow up incidence did not significantly differ between the different studied groups. Scleroligation allows very rapid eradication of varices, low recurrence rate, avoided the disadvantage of high recurrence of band ligation alone, and did not require special skill over sclerotherapy or band ligation but the total cost is higher than that required for sclerotherapy. Also, Band ligation plus argon plasma photocoagulation allows very rapid eradication of varices, and low recurrence rate, with no obvious recorded complications, but it has the disadvantage of being the most expensive technique and requires special machine which is not available except in few endoscopic centers