Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in peptic ulcer patients

Abstract

Vagus nerve may play a role in serum glucose modulation. The complicated peptic ulcer patients (with perforation or/and bleeding) who received surgical procedures with or without vagotomy provided 2 patient populations for studying the impact of vagus nerve integrity. We assessed the risk of developing type 2 diabetes in peptic ulcer patients without and with complications by surgical treatment received in a retrospective population study using the National Health Insurance database in Taiwan.A cohort of 163,385 patients with peptic ulcer and without Helicobacter pylori infection in 2000 to 2003 was established. A randomly selected cohort of 163,385 persons without peptic ulcer matched by age, sex, hypertension, hyperlipidemia, Charlson comorbidity index score, and index year was utilized for comparison. The risks of developing diabetes in both cohorts and in the complicated peptic ulcer patients who received truncal vagotomy or simple suture/hemostasis (SSH) were assessed at the end of 2011.The overall diabetes incidence was higher in patients with peptic ulcer than those without peptic ulcer (15.87 vs 12.60 per 1000 person-years) by an adjusted hazard ratio (aHR) of 1.43 (95% confidence interval [CI] = 1.40–1.47) based on the multivariable Cox proportional hazards regression analysis (competing risk). Comparing ulcer patients with truncal vagotomy and SSH or those without surgical treatment, the aHR was the lowest in the vagotomy group (0.48, 95% CI = 0.41–0.56).Peptic ulcer patients have an elevated risk of developing type 2 diabetes. Moreover, there were associations of vagus nerve severance and decreased risk of subsequent type 2 diabetes in complicated peptic ulcer patients.

A comparative study of subsequent liver cirrhosis risk in non‐Helicobacter pylori‐infected peptic ulcer patients with and without vagotomy: An Asian population cohort study

“…A recent study showed that vagotomy/drainage was superior to local oversewing in bleeding peptic ulcers that required emergency surgery . In addition, long‐term follow‐up studies showed that vagal nerve severance (vagotomy) decreased subsequent incidences of type 2 diabetes and ischemic heart disease in complicated peptic ulcer patients . These results indicate that persistent vagal hyperactivity may play an essential role in systemic homeostasis and there might be a role for vagal nerve severance in the management of patients with complicated peptic ulcer.…”

“…23,24 The likely explanations may include persistent vagal hyperactivity and increased systemic inflammatory status. 21,22 Other studies showed that vagal hyperactivity was related to the development of gastric stress ulceration, 16 and increased vagal parasympathetic tone was associated with peptic ulcer diseases in humans. 25,26 Those results indicate that there was an essential association between increased vagal tone and peptic ulcer.…”

“…Studies showed that patients with peptic ulcer had higher incidences of inflammatory diseases such as type 2 diabetes, ischemic heart disease, and ischemic stroke . The likely explanations may include persistent vagal hyperactivity and increased systemic inflammatory status .…”

“…Studies showed that patients with peptic ulcer had higher incidences of inflammatory diseases such as type 2 diabetes, ischemic heart disease, and ischemic stroke . The likely explanations may include persistent vagal hyperactivity and increased systemic inflammatory status . Other studies showed that vagal hyperactivity was related to the development of gastric stress ulceration, and increased vagal parasympathetic tone was associated with peptic ulcer diseases in humans .…”

Течение Пептических Гастродуоденальных Язв На фоне Коморбидного Сахарного Диабета

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ВведениеПо высокому уровню распространенности и экономическим затратам на лечение пептические язвы желудка (ЯЖ) и двенадцатиперстной кишки (ЯК) входят в число наиболее актуальных проблем современной медицины [1,2]. При этом сахарный диабет (СД) 2 типа является независимым фактором риска развития ЯЖ и ЯК [3-5], повышает частоту осложнений этих заболеваний [6], в частности, гастродуоденальных кровотечений [7][8][9]. Коморбидный СД увеличивает на 40-50 % смертность таких больных в течение первого месяца [10].

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