Ineffective esophageal motility is associated with diabetes mellitus end organ complications

BackgroundDiabetes Mellitus (DM) is known to induce a wide range of harmful effects on several organs, notably leading to ineffective esophageal motility (IEM). However, the relationship between DM and IEM is not fully elucidated. We aimed to determine the relationship between DM and IEM and to evaluate the impact of DM's end organ complications on IEM severity.MethodsA multicenter cohort study of consecutive patients undergoing high-resolution esophageal manometry (HREM) was performed. We reviewed medical records of patients diagnosed with IEM using HREM, encompassing data on demographics, DM history, antidiabetic and other medications as well as comorbidities.Key ResultsTwo hundred and forty six subjects met the inclusion criteria. There was no significant difference in any of the HREM parameters between diabetics and nondiabetics. Out of 246 patients, 92 were diabetics. Diabetics with neuropathy presented a significantly lower distal contractile integral (DCI) value compared to those without neuropathy (248.2 +/- 226.7 mmHg<middle dot>cm<middle dot>sec vs. 375.6 +/- 232.4 mmHg<middle dot>cm<middle dot>sec; p = 0.02) Similarly, the DCI was lower in diabetics with retinopathy compared to those without retinopathy (199.9 +/- 123.1 mmHg<middle dot>cm<middle dot>sec vs. 335.4 +/- 251.7 mmHg<middle dot>cm<middle dot>sec; p = 0.041). Additionally, a significant difference was observed in DCI values among DM patients with >= 2 comorbidities compared to those without comorbidities (224.8 +/- 161.0 mmHg<middle dot>cm<middle dot>sec vs. 394.2 +/- 243.6 mmHg<middle dot>cm<middle dot>sec; p = 0.025). Around 12.6% of the variation in DCI could be explained by its linear relationship with hemoglobin A1c (HbA1c), with a regression coefficient (beta) of -55.3.Conclusion & InferencesDM is significantly associated with IEM in patients with neuropathy, retinopathy, or multiple comorbidities. These results are pivotal for tailoring patient-specific management approaches. Diabetes Mellitus patients with neuropathy, retinopathy, or two or more comorbidities had lower DCI values compared to those without neuropathy, retinopathy, and less than two comorbidities. DCI values demonstrated a linear relationship with hemoglobin A1C, suggesting a link between glycemic control and esophageal motility.image