ACID PEPTIC DISEASE IN CHILDREN WITH TYPE-I DIABETES-MELLITUS - A COMPLICATING RELATIONSHIP

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.