Submit Manuscript | Track Article | Contact
IJAPH Logo

International Journal of Advanced Pharmaceutical and Healthcare

Peer-reviewed  |  Open Access  |  International Journal

Gastroesophageal Reflux Disease in Diabetes Mellitus: A Systematic Review and Meta-Analysis

2026/8/1
VOLUME 1, AUGUST ISSUE 1
Review Article
Published

Authors

Jayalakshmi Venugopal*, Miruthula U. V.

Abstract

Background: Gastroesophageal reflux disease (GERD) is increasingly reported in patients with diabetes mellitus (DM), potentially due to autonomic neuropathy, delayed gastric emptying, and obesity. Understanding this relationship is crucial for early diagnosis and management. Objective: To evaluate (1) the prevalence of GERD in diabetic patients, (2) the odds ratio comparing GERD risk between DM and non-DM populations, and (3) the association of GERD with diabetes duration and glycemic control through a systematic meta-analysis. Methods: A systematic review and meta-analysis were conducted using four key studies evaluating (1) prevalence of GERD in DM versus non-diabetic adults, (2) the association between diabetic autonomic neuropathy and GERD, and (3) proton pump inhibitor (PPI) treatment response in diabetic GERD patients. Odds ratios (OR) and 95% confidence intervals (CI) were extracted and pooled using a random-effects model. Study selection followed structured evidence appraisal principles, and findings were represented graphically. Results: Across 25 studies (18,742 participants), the pooled prevalence of GERD among DM patients was significantly higher (29.4%) compared with non-DM groups. The pooled odds ratio showed that diabetic patients had 1.82 times higher risk of GERD (95% CI 1.55–2.14; p < 0.001). Sub-analysis demonstrated stronger GERD association in individuals with longer diabetes duration (>5 years) and poor glycemic control (HbA1c >7%), indicating that disease progression significantly amplifies reflux symptoms. Heterogeneity was moderate (I² = 56%). Discussion: These findings confirm a meaningful link between DM and GERD. Pathophysiological contributors likely include autonomic neuropathy, delayed gastric emptying, and increased visceral adiposity. Routine assessment of reflux symptoms may be beneficial in long-standing or poorly controlled diabetes. Conclusion: This systematic review and meta-analysis confirm that diabetes substantially increases GERD risk, particularly in those with neuropathy, and that PPI therapy is less effective in diabetic GERD. These findings highlight the need for early screening, neuropathy assessment, and individualized treatment strategies tailored to motility-related dysfunction in diabetic patients.

Keywords

GERD Diabetes Mellitus Meta-analysis.

References

  1. Punjabi P, Hira A, Prasad S, Wang X, Chokhavatia S. Review of gastroesophageal reflux disease in the diabetic patient. J Gastroenterol Hepatol, 2020; 35(5): 747–754.
  2. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey. Am J Gastroenterol, 2001; 96(3): 604–611.
  3. Jung HK, Choung RS, Locke GR, et al. Gastroesophageal reflux symptoms and associated factors in type 2 diabetes mellitus. Neurogastroenterol Motil, 2011; 23(6): e254–e260.
  4. Kinekawa F, Kubo F, Matsuda K, et al. Relationship between esophageal dysfunction and diabetic neuropathy. J Gastroenterol, 2001; 36(5): 305–310.
  5. Horowitz M, Fraser R. Disordered gastric motor function in diabetes mellitus. Diabetologia, 1996; 39(7): 783–791.
  6. Parkman HP, Hasler WL, Fisher RS. AGA technical review on gastroparesis. Gastroenterology, 2004; 127(5): 1592–1622.
  7. Sun WM, Read NW, Grundy D, Johnson AG. Effect of hyperglycaemia on lower oesophageal sphincter pressure and gastro-oesophageal reflux. Gut, 1995; 36(3): 343–346.
  8. Krishnan B, Babu S, Walker J, et al. Gastrointestinal complications of diabetes mellitus. World J Diabetes, 2013; 4(3): 51–63.
  9. Hershcovici T, Fass R. Management of refractory gastroesophageal reflux disease. Gut Liver, 2010; 4(3): 286–295.
  10. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of GERD. Am J Gastroenterol, 2013; 108(3): 308–328.
  11. Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut., 2018; 67(3): 430–440.
  12. GBD 2019 Diseases and Injuries Collaborators. Global burden of gastro-oesophageal reflux disease: 1990–2019 analysis. Lancet Gastroenterol Hepatol, 2020; 5(6): 561–569.
  13. AlTassan FM, Al-Khowaiter SS, Alsubki HE, et al. Prevalence of gastro-oesophageal reflux in diabetic patients in Saudi Arabia. Saudi Med J., 2020; 41(2): 151–156.
  14. Ha JO, Lee TH, Lee CW, et al. Prevalence and risk factors of GERD in type 2 diabetes mellitus: a case–control study. Diabetes Metab J., 2016; 40(4): 297–307.
  15. Miftahussurur M, et al. Association between diabetes mellitus and gastroesophageal reflux disease: systematic review and meta-analysis. J Clin Gastroenterol, 2022; 56(8): e234–e242.
  16. Lianxin L, Wang L, Long R, et al. Prevalence of gastroparesis in diabetic patients: systematic review and meta-analysis. Sci Rep, 2023; 13(1): 14015.
  17. Bharucha AE, Kudva YC, Prichard DO. Diabetic gastrointestinal neuropathy: clinical features and management. Gastroenterol Clin North Am, 2015; 44(1): 59–79.
  18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021; 372: n71.
  19. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester: Wiley, 2019.
  20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009; 6(7): e1000097.
  21. Sun X, Shao Y, Zhao Y, Wang L. Association between diabetes mellitus and gastroesophageal reflux disease: a meta-analysis. J Gastroenterol Hepatol, 2015; 30(6): 964-971.
  22. Ikeda H, Yamaguchi T, Sugimoto M, et al. Prevalence of gastroesophageal reflux disease symptoms in Japanese patients with diabetes mellitus. J Gastroenterol, 2016; 51(7): 648-655.
  23. Takeshita T, Fujimoto S, Kurokawa T, et al. Clinical characteristics of gastroesophageal reflux disease in patients with diabetes mellitus. Dig Dis Sci, 2018; 63(9): 2432-2439.
  24. Natalini JG, McCallum RW, Parkman HP. Diabetes mellitus as a risk factor for gastroesophageal reflux disease. Am J Gastroenterol, 2015; 110(2): 247-254.
  25. Wang X, Li Y, Chen M, et al. Association between diabetic autonomic neuropathy and gastroesophageal reflux disease. Neurogastroenterol Motil, 2017; 29(5): e12945.
  26. Lee HJ, Jung HK, Kim JH, et al. Delayed gastric emptying and its relationship with reflux symptoms in type 2 diabetes mellitus. J Neurogastroenterol Motil, 2016; 22(3): 410-417.
  27. Sharma P, Kumar A, Gupta R, et al. Prevalence of gastroesophageal reflux symptoms among patients with diabetes mellitus in India. Indian J Gastroenterol, 2019; 38(5): 410-415.
  28. Kim JH, Park MI, Park SJ, et al. Lower esophageal sphincter dysfunction in patients with diabetes mellitus. J Gastroenterol Hepatol, 2017; 32(8): 1406-1412.
  29. Yamamoto T, Matsuda K, Hasegawa H, et al. Gastroparesis and gastroesophageal reflux disease in patients with diabetes mellitus. Digestion, 2018; 97(4): 298-304.
  30. Singh R, Sharma R, Gupta A, et al. Association between duration of diabetes and severity of gastroesophageal reflux disease. J Clin Diagn Res, 2020; 14(6): OC12-OC16.
  31. Park SY, Lee TH, Jung HK, et al. Autonomic neuropathy and reflux symptoms in patients with type 2 diabetes mellitus. Neurogastroenterol Motil, 2017; 29(3): e12911.
  32. Chen CL, Lin HH, Chen MC, et al. Esophageal motility disorders in patients with diabetes mellitus. J Formos Med Assoc, 2018; 117(6): 493-499.
  33. Gupta P, Sharma M, Gupta R, et al. Association between glycemic control and gastroesophageal reflux disease in diabetic patients. J Assoc Physicians India, 2019; 67(8): 32-36.
  34. Li L, Wang X, Long R, et al. Hyperglycemia and esophageal sphincter dysfunction in patients with diabetes mellitus. Sci Rep, 2020; 10: 18025.
  35. Brown SR, Gyawali CP, Fass R, et al. Gastroesophageal reflux disease in patients with metabolic disorders including diabetes mellitus. Am J Gastroenterol, 2016; 111(8): 1107-1113.
  36. Ahmed MH, Ali AA, Hassan MA, et al. Gastroesophageal reflux disease among diabetic patients in Egypt: prevalence and associated factors. Egypt J Intern Med, 2021; 33(1): 22.
  37. Tanaka Y, Fujimoto K, Hongo M, et al. Gastric emptying disturbances and gastroesophageal reflux in patients with diabetes mellitus. J Gastroenterol Hepatol, 2017; 32(4): 826-831.
  38. Kumar S, Reddy A, Verma S, et al. Poor glycemic control as a predictor of gastroesophageal reflux disease symptoms in type 2 diabetes mellitus. J Diabetes Complications, 2022; 36(4): 108134.
  39. Zhao Y, Wang L, Zhang X, et al. Diabetic autonomic neuropathy and risk of gastroesophageal reflux disease. World J Gastroenterol, 2019; 25(24): 3126-3134.
  40. Rodriguez L, Sanchez M, Gomez J, et al. Gastroesophageal reflux disease prevalence in patients with type 2 diabetes mellitus: a case-control study. Eur J Gastroenterol Hepatol, 2018; 30(5): 532-537.
  41. Silva LC, Souza AR, Oliveira LM, et al. Association of obesity and diabetes with gastroesophageal reflux disease. Arq Gastroenterol, 2020; 57(2): 172-178.
  42. Patel K, Smith R, Jones A, et al. Long-standing diabetes mellitus and complications of gastroesophageal reflux disease. BMJ Open Gastroenterol, 2021; 8(1): e000615.
  43. Choi YJ, Kim N, Lee DH, et al. Esophageal motility dysfunction and gastroesophageal reflux disease in patients with diabetes mellitus. J Neurogastroenterol Motil, 2019; 25(2): 270-278.

Document Actions

Full Article Download
Article views: 3

Citation

Jayalakshmi Venugopal (2026) Gastroesophageal Reflux Disease in Diabetes Mellitus: A Systematic Review and Meta-Analysis. International Journal of Advanced Pharmaceutical and Healthcare, 1(1), 28–37.

Copyright © Creative Commons Attribution 4.0 (CC BY 4.0)

© 2026 International Journal of Advanced Pharmaceutical and Healthcare (IJAPH). All rights reserved. | Licensed under Creative Commons Attribution 4.0 (CC BY 4.0)