Prevalence Of Upper Gastrointestinal Symptoms Research Articles

S508 Upper Gastrointestinal Manifestations of SARS-CoV-2 Infection in the United States: A Population-Based Study

Introduction: Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infection are frequently reported and correlate with disease severity and mortality. Our study aimed to assess the association between upper gastrointestinal (GI) disorders and upper GI symptoms with COVID-19 infection. Methods: We queried a large multi-center database (Explorys Inc., Cleveland, OH, USA), an aggregate of electronic health records of 26 different healthcare systems with 360 hospitals. In the last two years, we identified patients with a Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of “COVID-19”. We compared Demographic data and clinical characteristics of patients with and without a diagnosis of COVID-19. Results: Among the 70,039,864 individuals included in this database, 34,720 individuals were diagnosed with a COVID-19 infection, a prevalence rate of 493 per 100,000 in the US population. COVID-19 infection was more commonly associated with patients of age >65 years (OR 1.18, p < 0.0001) and in African American (OR 2.90, p < 0.0001). There was no statistically significant gender-based differences. COVID-19 patients were more likely to be suffer from upper GI disorders such as gastritis (OR 4.38), gastroesophageal reflux disease (GERD) (OR 6.02), esophagitis (OR 3.84), upper GI bleeding (OR 4.91), and duodenitis (OR 4.95), p < 0.0001 to all. COVID-19 patients were also found to be more likely to have upper GI symptoms such as nausea and vomiting (OR 4.12), abdominal pain (OR 3.70), loss of appetite (OR 3.27), weight loss (OR 2.98), and dysphagia (OR 11.84), p< 0.0001 to all (Figure). Conclusion: In this large population-based study, we found an increased association of upper GI symptoms and upper GI disorders with a diagnosis of COVID-19 infection. It is unclear if patients with a concomitant upper GI etiology have a prolonged or more severe clinical course or prolonged virus shedding in GI specimens. Further prospective studies are required to evaluate this association. (Table)Figure 1.: A comparison of the prevalence of upper gastrointestinal symptoms and conditions in patients with and without COVID-19 infection. Table 1. - A comparison of the baseline characteristics and upper gastrointestinal conditions and symptoms of patients with and without COVID-19 infection COVID-19 patients (n, %) Non-COVID-19 patients (n, %) OR CI p-value Demographics Age: 18-65 23,030 (66%) 47,926,050 (68%) 0.92 0.90 to 0.94 < 0.0001 Age: >65 11,730 (34%) 21,254,620 (30%) 1.18 1.15 to 1.21 < 0.0001 Male 15,620 (45%) 31,412,530 (45%) 1.01 0.99 to 1.04 0.1954 Female 19,060 (55%) 38,452,220 (55%) 1.01 0.99 to 1.03 0.3521 Caucasian 16,680 (48%) 37,840,470 (54%) 0.79 0.78 to 0.81 < 0.0001 African American 8,440 (24%) 7,023,300 (10%) 2.9 2.83 to 2.97 < 0.0001 Upper GI Conditions and Symptoms Gastritis 800 (2%) 376,990 (0.5%) 4.38 4.08-4.70 < 0.0001 GERD 3,140 (9%) 1,142,660 (1.6%) 6.02 5.81-6.25 < 0.0001 Esophagitis 250 (0.7%) 132,790 (0.2%) 3.84 3.39-.35 < 0.0001 Duodenitis 110 (0.3%) 45,130 (0.01%) 4.95 4.11-5.97 < 0.0001 Upper GI bleed 160 (0.5%) 66,230 (0.1%) 4.91 4.21-.74 < 0.0001 Nausea and vomiting 740 (3%) 370,390 (0.5%) 4.12 3.83-4.43 < 0.0001 Abdominal pain 2,240 (7%) 1,286,290 (1.8%) 3.70 3.55-3.87 < 0.0001 Loss appetite 230 (0.7%) 143,250 (0.2%) 3.27 2.87-3.72 < 0.0001 Weight loss 350 (1%) 239,400 (0.3%) 2.98 2.69-3.31 < 0.0001 Dysphagia 760 (2%) 132,790 (0.2%) 11.84 11.01-12.72 < 0.0001 Univariate analysis used to calculate OR. OR; odd ratio. CI; confidence interval.

Trends in proton pump inhibitor use, reflux esophagitis, and various upper gastrointestinal symptoms from 2010 to 2019 in Japan.

The increasing usage of proton pump inhibitors (PPIs) has been reported worldwide, but information on PPI use in East Asia is inadequate. This study aimed to examine the trends in PPI use in Japan, along with the changes in histamine H2 receptor antagonist (H2RA) use, disease rate of reflux esophagitis, and the prevalence of upper gastrointestinal symptoms. We analyzed 217,712 healthy subjects (127,607 men and 90,105 women; 51.4 ± 9.7 years old) participating in the health check program from 2010 to 2019. Various upper gastrointestinal symptoms were evaluated using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire. Reflux esophagitis was diagnosed by esophageal erosion using the Los Angeles classification grades A, B, C, and D. From 2010 to 2019, the percentage of PPI users increased markedly from approximately 1.8% to 5.3%, whereas that of H2RA users decreased gradually from approximately 2.5% to 1.9%. The use of all classical types of PPIs (omeprazole, lansoprazole, rabeprazole, and esomerazole) and a new type of PPI, a potassium-competitive acid blocker (vonoprazan), greatly increased during the 10 years. An upward trend in the prevalence of reflux esophagitis was observed from 2010 to 2015, but not from 2016 to 2019, indicating that the monotonic rising prevalence of reflux disease stopped in the middle of the 2010s in Japan. In contrast, various upper gastrointestinal symptoms significantly improved between 2010 and 2019. All 12 FSSG symptoms of PPI users were significantly worse than those of non-PPI users, suggesting that PPIs still cannot completely control upper gastrointestinal symptoms. In conclusion, this study revealed a significant increase in PPI use and a slight decrease in H2RA use from 2010 to 2019. Despite a plateau in the prevalence of reflux esophagitis and considerable improvement in various upper gastrointestinal symptoms, PPI use has continued to increase in Japan.

Upper gastrointestinal complaints in celiac patients at diagnosis. Association with endoscopic and histopathological findings.

This study investigated the prevalence of upper gastrointestinal symptoms in Brazilian patients at the time of diagnosis with celiac disease (CD), associating them with endoscopic and histopathological findings. A retrospective study was performed including adult patients diagnosed with CD from January 2013 to December 2019.

Impact of Laparoscopic Sleeve Gastrectomy on Upper Gastrointestinal Symptoms

Altered gastric anatomy following laparoscopic sleeve gastrectomy (LSG) is likely to induce upper gastrointestinal (GI) symptoms. Published studies, however, have focused mainly on gastroesophageal reflux disease (GERD). This study aims to evaluate LSG's impact on the prevalence of upper GI symptoms and to assess the effects of time from surgery, weight loss, and proton pump inhibitor (PPI) therapy. The validated Rome III Criteria symptom questionnaire for upper GI symptoms, including quality of life items, has been self-administered to 97 patients who underwent LSG. Symptoms were analyzed either separately or altogether to classify patients in GERD or dyspepsia, subdivided in epigastric pain (EPS) and post-prandial distress (PDS) syndromes. Before LSG, 52.7% of the patients were asymptomatic, 27.0% had GERD, and 8.1% had dyspepsia (2.7% EPS, 5.4% PDS). After a median follow-up of 13 months, 91.9% of the patients complained of upper GI symptoms, the most prevalent being PDS (59.4 %). GERD prevalence did not differ before and after LSG. The only symptom strongly related to LSG was dysphagia (OR 4.7, 95% CI 1.3-20.4, p = 0.015), which was present in 19.7% of the patients and mainly associated with PDS rather than GERD. GI symptoms, however, did not have a great impact on quality of life. Time from surgery, weight loss after surgery, as well as concomitant PPI, did not influence the symptoms. After a median follow-up of 13 months, PDS-like dyspepsia, rather than GERD, was the main complaint, both poorly responding to PPI therapy. A longer follow-up will be necessary to evaluate their future persistency.

Prevalence of Upper Gastrointestinal Symptoms and Their Influence on Nutritional State and Performance Status in Patients With Different Primary Tumors Receiving Palliative Care

The aim of this study was to investigate the relationship between gastrointestinal symptoms, nutritional balance, and performance status in patients receiving palliative care for advanced cancers originating in different sites. We studied a total of 105 patients. Upper gastrointestinal symptoms, Eastern Cooperative Oncology Group Performance Status score (ECOG-PS), dietary intakes, anthropometric measures, and some serum proteins were determined. Unintentional weight loss, alterations in anthropometric measures, and highest number of symptoms were greater in patients with lung and stomach cancer. No differences were found in ECOG-PS according to cancer site. Patients with gastric or lung cancer have most evidence of protein-calorie malnutrition and a higher prevalence of upper gastrointestinal symptoms. The performance status is not affected by tumor site. Early nutritional support should be planned for all patients with cancer, especially for patients with gastric or lung cancer.

A 13-nation population survey of upper gastrointestinal symptoms: prevalence of symptoms and socioeconomic factors

Previous data collected in separate studies using various different survey instruments have suggested some variability in the prevalence of symptoms between nations. However, there is a lack of studies which assess and compare the prevalence of upper gastrointestinal symptoms contemporaneously in various countries using a uniform, standardised method. To determine the prevalence of upper gastrointestinal (UGI) symptoms in 13 European countries, and the association between socioeconomic factors and symptoms using a standardised method. A representative age- and gender-stratified sample of 23,163 subjects (aged 18-69 years) was surveyed. The prevalence of UGI symptoms was 38%. UGI symptoms were most prevalent in Hungary [45%, 95% confidence interval (CI): 42.2-48.4] and lowest in the Netherlands (24%, 95% CI: 21.0-26.2). UGI symptoms were more prevalent in women (39%, 95% CI: 38.4-39.6) vs. men (37%, 95% CI: 36.4-37.6). Heartburn (24%, 95% CI: 23.4-24.6) and acidic reflux (14%, 95% CI: 13.6-14.4) were most common. With age, the prevalence of UGI symptoms decreased (e.g. 18-29 years: 43%, 95% CI: 41.4-44.3 vs. 50-69 years: 33%, 95% CI: 32.3-34.4); in contrast, the frequency of symptom episodes/year increased with age (e.g. 18-29 years: 11.3 episodes per years, 95% CI: 10.5-12.1 vs. 50-69 years: 21.8, 95% CI: 20.7-22.9). Socioeconomic status as measured by gross domestic product was inversely associated with symptoms and in total, socioeconomic factors, gender, body mass index, smoking habits and alcohol consumption explained 83% of the variance of UGI symptoms. There are marked differences in the country specific prevalence of upper gastrointestinal complaints. Socioeconomic factors are closely associated with the prevalence of upper gastrointestinal symptoms.

Association of upper gastrointestinal symptoms with functional and clinical charateristics in elderly

To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and demographic characteristics, function in the activities of daily living (ADL), co-morbidities and drug use were collected by a structured interview. Upper gastrointestinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters: (1) abdominal pain syndrome; (2) reflux syndrome; (3) indigestion syndrome; (4) bleeding; and (5) non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointestinal symptoms was 43.0%, i.e. cluster (1) 13.9%, (2) 21.9%, (3) 30.2%, (4) 1.2%, and (5) 4.5%. Upper gastrointestinal symptoms were more frequently reported by females (P < 0.0001), with high number of co-morbidities (P < 0.0001), who were taking higher number of drugs (P < 0.0001) and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex (OR = 1.39, 95% CI: 1.17-1.64), disability in the ADL (OR = 1.47, 95% CI: 1.12-1.93), smoking habit (OR = 1.29, 95% CI: 1.00-1.65), and body mass index (OR = 1.06, 95% CI: 1.04-1.08), as well as the presence of upper (OR = 3.01, 95% CI: 2.52-3.60) and lower gastroenterological diseases (OR = 2.25, 95%CI: 1.70-2.97), psychiatric (OR = 1.60, 95% CI: 1.28-2.01) and respiratory diseases (OR = 1.25, 95% CI: 1.01-1.54) were significantly associated with the presence of upper gastrointestinal symptoms. Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symptoms in older subjects.

Diabetic factors associated with gastrointestinal symptoms in patients with type 2 diabetes

To determine whether gastrointestinal (GI) symptoms are more frequent in type 2 diabetic patients and to examine which diabetic factors are associated with the symptoms. Consecutive subjects with diabetes and age-/gender-matched normal controls were recruited for this study. GI symptoms were assessed using a structured questionnaire divided into two GI symptom categories (upper and lower GI symptoms), and consisting of 11 individual symptoms. In the diabetic patient group, diabetic complications including peripheral neuropathy, nephropathy and retinopathy, glycosylated hemoglobin (HbA1c) level and diabetes duration were evaluated. Among the total 190 diabetic patients and 190 controls enrolled, 137 (72%) of the diabetic patients and 116 (62%) of the controls had GI symptoms. In the diabetic patient group, 83 (43%) had upper GI symptoms and 110 (58%) lower GI symptoms; in the control group, 59 (31%) had upper GI symptoms and 104 (55%) lower GI symptoms. This difference between the two groups was significant for only the upper GI symptoms (P = 0.02). Among the diabetic factors, the HbA1c level was the only independent risk factor for upper GI symptoms in the multiple logistic regression analysis (odds ratio = 2.01, 95% confidence interval: 1.02-3.95). Type 2 diabetes was associated with an increased prevalence of upper GI symptoms and these symptoms appeared to be independently linked to poor glycemic control, as measured by the HbA1c levels.

Prevalence of Upper Gastrointestinal Symptoms Among School Age Children: A Community-Based Study

Objective: To measure the prevalence of upper gastrointestinal (GI) symptoms among children in the Houston, Texas community and describe the clinical constellation and natural history of upper (GI) symptoms in children. Methods: A cross-sectional study was conducted on school children in Houston, Texas. After informed consent, parents of children attending two middle schools and one elementary school completed a standardized questionnaire concerning socioeconomic parameters, and upper abdominal pain discomfort. A subset of children completed a questionnaire regarding the presence, the frequency, and the intensity of upper (GI) symptoms that included heartburn, nausea/vomiting, belching, loss of appetite, and or bloating. The frequency and the intensity of the symptoms were categorized into 5 ratings; never, less than once/month, 1-3 times/month, once/week and more than once a week. Results: 700 children/parents completed the questionnaire about the presence/absence of abdominal pain. The overall prevalence of abdominal pain (AP) was 24%. 348 children completed a questionnaire about upper (GI) symptoms; 48% with AP and 52% without AP. The mean age of the children was 9.5 years, 38% African-Americans, 42% Hispanics, and 20% Caucasians. The overall prevalence of one or more of upper (GI) symptoms occurring at least 1-3 times/month was 38% and occurring once/week or more was 24%. There were no ethnic differences in the prevalence of upper (GI) symptoms occurring weekly between Black, Hispanic or White children; 25%, 22%, and 28%, respectively, p = 0.7, nor between boys and girls, p = 0.6. Abdominal pain was not associated with upper (GI) symptoms; (OR = 1.3, 95% CI = 0.8-2.1, p = 0.17). In a final logistic regression model, age, ethnicity, and the presence of AP were not associated with the upper (GI) symptoms. Conclusion: There is a high prevalence of upper (GI) symptoms among school age children in Houston, Texas, that is severe enough to occur more than once/week. This is a higher prevalence than other reports (Hyams-2000). Abdominal pain is not associated with upper GI symptoms in children. Further community studies are needed to identify who seek medical advice and who use over the counter medication to relive their upper (GI) symptoms.

Upper Gastrointestinal Symptoms and Climate Exchange in Indonesian Hajj Pilgrims: Community Based Study Islamic Year 1427

Background : Upper gastrointestinal symptoms rank among the three most common diseases for Indonesian hajj pilgrims in last 4 years. The prevalence was 22-34% per hajj season. Most of the cases were dyspepsia syndrome and Gastro Esophageal Reflux Disease (GERD). The internal risk factor of Upper gastrointestinal symptoms is largely known, but not for external factor such as environment and climate. Aim : To examine the association between climate exchange and upper gastrointestinal symptoms Methods : Dynamic population of 204,941 Indonesian Hajj Pilgrims in Islamic year 1427 were included for this study. Multiphase screening in Indonesia found the prevalence of upper gastrointestinal symptoms was 3.32%. Prospective follow up for upper gastrointestinal symptom-based on community health services (flight group/kloter and maktab policlinic/polimaktab) and hospital base (Sub Balai Pengobatan Haji Indonesia, Balai Pengobatan Haji Indonesia [BPHI] and Saudi Arabia hospital) was conducted in Saudi Arabia. Results : The incidence rate of the upper gastrointestinal symptoms was 2.4 per mile (95% CI = 1.8 -3.1). There was no significant difference among male and female p = 0.279 (95% CI = 0.18- 5.3) and there was significant difference among work area (Daker) p = 0.001 (95% CI = 50.4-182.5). There was no significant correlation between upper gastrointestinal symptoms and temperature or humidity in 3 work area (p = 0.155) Mecca, Medina and Jeddah. Conclusion : There was no significant correlation between climate exchanges to the upper gastrointestinal symptoms. Keywords : upper gastrointestinal symptoms, Indonesian Hajj Pilgrims, dyspepsia, GERD

Relationships between the adverse effects of drugs and genetic polymorphism in genes encoding drug metabolizing enzymes

Van Oijen et al. reported in the Journal [1] an investigation which aimed to ‘assess whether polymorphisms in UGT1A6 and CYP2C9 were related to the prevalence of upper gastrointestinal symptoms in cardiovascular patients using acetylsalicylic acid for the secondary prevention of ischaemic heart disease’. The study was based on the assertion that UGT1A6 and CYP2C9 mediate the glucuronidation and hydroxylation of acetylsalicylic acid (aspirin; ASA), respectively, although no references were provided to support this proposition. There was no significant association between UGT1A6 and CYP2C9 genotypes and the incidence of gastrointestinal adverse effects in 160 patients receiving ASA. Not discounting other important issues associated with the study, particularly unavailability of the ASA dose(s) received by patients, we wish to comment on the theoretical basis for the investigation. The metabolism of ASA is well characterized (reviewed in [2]). ASA itself is not glucuronidated or hydroxylated. Rather, ASA is hydrolyzed to the pharmacologically active salicylic acid (SA) by esterases in the gastrointestinal tract and liver, and only approximately 50–70% of the dose reaches the systemic circulation as unchanged drug following oral administration. ASA escaping first pass extraction is rapidly hydrolyzed to SA with a half-life of about 15 min. Once formed, SA is metabolized to salicyluric acid (SUA; the glycine conjugate), phenolic- (SPG) and acyl- (SAG) glucuronides, and gentisic acid (2,5-dihydroxybenzoic acid; GA). SUA is the major metabolite of SA. In subjects administered 900 mg of ASA, SUA accounted on average for 68% of the dose recovered in urine [3]. SA, SPG, SAG and GA accounted for 12.2%, 10.6%, 8.2% and 1.4% of the recovered dose, respectively. Although formation clearances of SUA and SPG are known to be dose-dependent [4], SA clearance via the SUA pathway is, on average, about three-fold higher than by glucuronidation while hydroxylation to form GA represents a very minor pathway of SA elimination. In contrast to ASA, the elimination half-life of SA (the precursor of GA and the glucuronide conjugates) ranges from a few hours to almost 1 day, depending on the dose. SUA is formed in a two-step process; the first, and activating, step involves formation of a CoA thioester (mediated by a ‘medium chain’ CoA ligase) which is subsequently acylated by glycine N-acyltransferase. The UDP-glucuronosyltransferase(s) (UGT) involved in SA metabolism has not been characterized unambiguously. Ciotti et al.[5] reported that recombinant UGT1A6 glucuronidated SA, but activity was very low (0.05 pmol glucuronide min−1) and relative formation of SPG and SAG was not assessed. More recently, multiple UGTs have been shown to have the capacity to catalyze both the phenolic and acyl glucuronidation of SA [6]; these include UGT 1A1, 1A3, 1A6, 1A7, 1A9, 1A10, 2B4 and 2B7. (It should be noted that UGT 1A7 and 1A10 appear to be expressed only in the gastrointestinal tract, while the other forms are expressed in liver and variably in other tissues). It was not possible from the data presented to ascertain the dominant UGT(s) involved in SPG and SAG formation. To the best of our knowledge, the role of CYP2C9 and other P450s in GA formation has not been assessed in a systematic manner. Thus, the conclusions of van Oijen et al.[1] are hardly surprising. Glucuronidation accounts, on average, for about 20% of SA metabolic clearance and UGT1A6 appears to be just one of several enzymes involved in SAG and SPG formation. GA is a very minor metabolite of SA (approx. 1%) and a role for CYP2C9 as the principal catalyst for the conversion of SA to GA has not apparently been demonstrated. Other studies have also investigated relationships between ASA response and CYP2C9 and UGT1A6 polymorphisms. Bigler et al.[7] reported an inverse relationship between colon adenoma risk and ASA ‘use’ in subjects with a CYP2C9*1/variant UGT1A6 genotype. In contrast, McGreavey et al.[8] found that polymorphisms in CYP2C9 and UGT1A6 (and some other genes) did not influence the protective effect of NSAIDs, either including or excluding ASA use, on the risk of colorectal cancer. Relationships between mutations in genes encoding xenobiotic metabolizing enzyme(s) and the response to compounds eliminated or metabolically activated by a polymorphic enzyme (e.g. CYP2C9, CYP2D6, UGT1A1) have been demonstrated in numerous studies. However, clinically meaningful, generalizable conclusions should not be expected from pharmacogenetic studies based on flawed knowledge of the enzyme(s) responsible for metabolite formation and where the relative contribution of the metabolic pathway to overall elimination (e.g. GA formation) is negligible.

Polymorphisms in genes encoding acetylsalicylic acid metabolizing enzymes are unrelated to upper gastrointestinal health in cardiovascular patients on acetylsalicylic acid

As acetylsalicylic acid is metabolized by UDP-glucuronosyltransferase 1A6 (UGT1A6) and cytochrome P450 2C9 (CYP2C9), interindividual differences in activity of these enzymes may modulate the effects and side-effects of acetylsalicylic acid. The objective of this study was to assess whether polymorphisms in UGT1A6 and CYP2C9 genes are related to the prevalence of upper gastrointestinal symptoms in cardiovascular patients using acetylsalicylic acid for secondary prevention of ischaemic heart disease. Blood samples were taken from acetylsalicylic acid using patients admitted to the Coronary Care Unit. Dyspepsia-related health was evaluated at week 2, using a validated upper gastrointestinal complaint questionnaire. A subset of 160 patients responded to a survey and were eligible to participate in this study. DNA was isolated and UGT1A6 and CYP2C9 genotypes were determined using polymerase chain reaction restricted fragment length polymorphism techniques. Seventy per cent of the patients returned the questionnaire. UGT1A6 and CYP2C9 variant polymorphisms were found in 103 (63%) and 56 (35%) patients, respectively. There was no association between gastrointestinal symptoms and UGT1A6 (OR = 0.80, 95% CI = 0.41-1.56) or CYP2C9 polymorphisms (OR = 0.85, 95% CI = 0.44-1.67). There was no association between polymorphisms in genes encoding for acetylsalicylic acid metabolizing enzymes on the prevalence of gastric complaints in cardiovascular patients on acetylsalicylic acid.

Prevalence of upper gastrointestinal symptoms and impact on disability days

Prevalence of upper gastrointestinal symptoms and impact on disability days

Upper gastrointestinal symptoms and therapies in elderly out‐patients, users of non‐selective NSAIDs or coxibs

The association between coxib or non-steroidal anti-inflammatory drug use with gastrointestinal symptoms and drug prescriptions in ambulatory elderly patients is not well defined. To evaluate the association between non-steroidal anti-inflammatory drug NSAID and coxib use with gastrointestinal symptoms and therapies in elderly subjects managed by their general practitioner. The study was carried out by 133 general practitioners in Italy. By using a structured interview, sex, age, physical function, current medications, new drug prescriptions and upper gastrointestinal symptoms were registered from all elderly subjects who were referred to their general practitioners during a 2-week period. The numbers of hospitalizations, gastrointestinal bleeding events and gastrointestinal diagnostic procedures occurring during the last 6-month period were recorded. Included in this study were 5515 elderly subjects. The overall prevalence of drug use was 92%. Musculo-skeletal drugs were taken by 15% of patients; NSAIDs were taken by 6%, and coxibs by 3% of patients. A significantly higher prevalence of upper gastrointestinal symptoms was observed in elderly NSAID users compared with coxib users and non-users of musculo-skeletal drugs (44% vs. 33% vs. 32% respectively, P = 0.001). The prescriptions of drugs for acid-related disorders were significantly higher in patients who were concomitantly taking NSAID rather than coxibs (13% vs. 6%, P < 0.01). The prescriptions of drugs for acid-related disorders were significantly associated with the presence of upper gastrointestinal symptoms (OR = 1.7, 95% CI = 1.6-1.9), previous gastrointestinal disorders (OR = 1.1, 95% CI = 1.0-1.3) and NSAID use (OR = 1.5, 95% CI = 1.0-2.2), but no coxib use. In this elderly population, upper gastrointestinal symptoms and prescriptions for gastroenterological drugs were higher in non-steroidal anti-inflammatory drug users than coxib users and non-users of musculo-skeletal drugs.

A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms

Despite the high prevalence of upper gastrointestinal symptoms and associated costs of diagnosis and management, evidence regarding long-term outcomes is scant. We studied symptom outcomes 18 months (FU1) and 8/9 years (FU2) post-index endoscopy to identify demographic, diagnostic and treatment factors associated with outcomes. A retrospective review of medical records at two Australian teaching hospitals identified a cohort of 302 patients who had an index endoscopy (performed by 23 endoscopists) 18 months previously. Patients were interviewed at FU1 and FU2. In total 34% (95%CI: 29.0 39.8) of patients were asymptomatic at FUI and 41% (95%CI: 35.6-46.6) at FU2. For 63%, outcomes at FUI predicted long-term outcome, with 19% (95%CI: 14.6-23.4) asymptomatic and 44% (95%CI: 38.4-50.0) symptomatic at both times. Those whose symptom status changed were as likely to deteriorate as improve (p > 0.05). Number and severity of presenting symptoms (F = 3.3, df = 3,277, p < 0.05) and older age (F = 2.8, df = 2,301, p < 0.05) were associated with poorer outcomes. Long-term outcome was unrelated to endoscopic diagnosis. Those symptomatic were significantly more likely to be on proton pump inhibitors (PPIs) or Histamine2 Receptor Antagonists (H2RAs) than those who were asymptomatic. Use of PPIs at FU2 was associated with a significantly better outcome than use of H2RAs. However this impact was relatively small, with 69% of patients on PPIs and 84% on H2RAs symptomatic at FU2. Upper gastrointestinal symptoms prompting endoscopy are chronic for the majority of patients regardless of diagnosis. Endoscopic diagnosis is of limited value in predicting long-term outcomes. The association between poor outcome and use of H2RAs and PPIs challenges views about their long-term effectiveness in symptom control.

Prevalence and Socioeconomic Impact of Upper Gastrointestinal Disorders in the United States: Results of the US Upper Gastrointestinal Study

This study examined the prevalence of upper gastrointestinal (GI) symptoms and symptom groupings and determined impact on disability days in a nationally representative US sample. A telephone survey of 21,128 adults was conducted including questions about the presence of upper GI symptoms during the past 3 months. Respondents were categorized as symptomatic (ie, reported GI symptoms once per month) or asymptomatic. The survey included questions about missed work, leisure activity, or household activity days. Symptom groupings were identified by using factor analysis, and cluster analysis was used to assign respondents into distinct groups on the basis of these symptom groupings. The prevalence of an average of 1 or more upper GI symptoms during the past 3 months was 44.9%. The most common symptoms experienced during the past 3 months were early satiety, heartburn, and postprandial fullness. Factor analysis identified 4 symptom groupings: (1) heartburn/regurgitation; (2) nausea/vomiting; (3) bloating/abdominal pain; and (4) early satiety/loss of appetite. Five respondent clusters were identified; the largest clusters were primarily early satiety/fullness (44%) and gastroesophageal reflux disease-like symptoms (28%). Two small clusters reflected nausea and vomiting (7%) and a heterogeneous symptom profile (4%). Symptomatic respondents reported significantly more missed work, leisure, and household activity days than asymptomatic respondents (all P < .0001). Factor analysis separated GI symptoms into groupings reflecting gastroesophageal reflux disease and dyspepsia: early satiety, postprandial fullness, and loss of appetite; bloating and abdominal pain/discomfort; and nausea and vomiting. These upper GI symptoms were associated with significant loss of work and activity days.

IS DYSPEPSIA MORE PREVALENT IN FUNCTIONAL CONSTIPATION THAN FUNCTIONAL DIARRHEA? A POPULATION-BASED STUDY

Purpose: In chronic constipation, disturbed gastric and small bowel transit as well as abnormal esophageal motility has been demonstrated. The aim of this study was to determine if the prevalence of dyspepsia is higher in subjects with functional constipation than diarrhea. We conducted a cross-sectional study to examine the prevalence of upper gastrointestinal symptoms in subjects with chronic colonic symptoms. Methods: 1069 employees of an integrated healthcare system were mailed a validated questionnaires inquiring about their upper and lower gastrointestinal symptoms (validated Bowel Disease Questionnaire). Definitions of dyspepsia subgroups (including dysmotility, reflux and ulcer-like), functional constipation and diarrhea were based on the Rome I criteria. Reflux-like dyspepsia was defined as having dyspepsia according to the Rome criteria with heartburn and/or reflux once a week or more. Results: 723 subjects (response rate 72%) returned the survey (age range 24–77). One hundred and forty (19.4%) subjects reported constipation and 10.9% reported diarrhea. Symptoms of dyspepsia were reported by 14.7% of subjects (6.2% ulcer-like, 6.1% dysmotility-like, and 9.4% reflux-like dyspepsia). Controlling for age, constipation was more common in females (OR 1.95, 95% CI 1.29-2.95, p < 0.01), whereas diarrhea and dyspepsia (including its subgroups) were not associated with gender (all p>41). Dyspepsia (including ulcer-like and reflux-like) was slightly more common in subjects with constipation than diarrhea but the differences were not significant (all p>0.25) (Table). On individual symptom analysis, heartburn (7% vs. 3%) and acid regurgitation (4% vs. 2%) were more common in subjects with constipation than diarrhea, but these differences were not significant (all p >0.23)Table: Prevalence and 95% CI of dyspepsia and dyspepsia subtypes in subjects with constipation and diarrheaConclusions: There is considerable overlap of upper gastrointestinal symptoms in both functional constipation and diarrhea. The prevalence of symptoms of dyspepsia and its subgroups are not significantly higher in subjects with constipation than diarrhea.

NSAID and aspirin use by the elderly in general practice: effect on gastrointestinal symptoms and therapies.

The relationship between NSAID use and gastrointestinal (GI) symptoms and their treatment in elderly patients is not well defined. To identify the prevalence of specific drug use in elderly outpatients and to identify the relationship between NSAID use and GI disturbances and treatments in elderly subjects treated by their general practitioner (GP). The study was carried out by 63 GPs in north-eastern Italy; 3154 elderly subjects were included in the study over a 2-week period. By using a structured interview, subjects' medical histories and current medication were identified. In particular, the presence and use pattern (i.e. occasional, 'acute' or 'chronic') of NSAIDs and/or aspirin (acetylsalicylic acid) were recorded. In all subjects, the presence of upper GI symptoms, i.e. abdominal pain, reflux symptoms and indigestion syndrome, were noted. The prevalence of drug use was 96.4% (males 96%, females 96.7%). The most prescribed drugs were ACE inhibitors (38%), diuretics (26.7%), NSAIDs and regular-dose aspirin (24.7%), GI drugs (20.6%), and anxiolytics/hypnotics (20.3%). Of 779 subjects who had taken NSAIDs or regular-dose aspirin, 32.9% were 'chronic' users, 24.9% were 'acute' users and 42.1% occasional users. A significantly higher prevalence of upper GI symptoms was observed in elderly NSAID and low-dose aspirin users compared with non-users (24.9% vs 28% vs 16.6% respectively, p < 0.0001). GI symptoms were reported by 27.6% of 'chronic' NSAID users, 22.9% of 'acute' users and 24.7% of occasional users. A significantly higher prescription rate for any GI drug was found in NSAID users than in low-dose aspirin users and non-users (24.0% vs 19.6% vs 19.4% respectively, p = 0.007). This difference was mainly because of a higher number of upper GI drugs taken by NSAID users than by low-dose aspirin users and non-users (18.1% vs 16% vs 13.7% respectively, p = 0.004). Multivariate analysis demonstrated that female gender (odds ratio [OR] = 1.32, 95% CI = 1.16-1.44), low-dose aspirin (OR = 1.88, 95% CI = 1.33-2.65), NSAIDs and/or regular-dose aspirin (OR = 1.48, 95% CI = 1.19-1.83) and multiple therapies, i.e. taking more than four drugs per day (OR = 1.42, 95% CI = 1.14-1.77) were risk factors for GI symptoms in elderly outpatients. NSAIDs and/or aspirin use was very high in this elderly outpatient population. The use of these drugs was significantly associated with a greater number of upper GI symptoms and prescriptions for GI drugs. Educational and clinical strategies need to be implemented in order to reduce the GI impact of NSAID and aspirin use in elderly people.

Upper gastrointestinal symptoms in North America: prevalence and relationship to healthcare utilization and quality of life.

The aim of this study was to determine the prevalence of upper gastrointestinal symptoms (UGIS) in a general population and quantify the relationship of those symptoms to healthcare utilization and quality of life. In-person interviews were conducted with 2056 United States and Canadian residents selected at random. Subjects reported frequency and severity for 11 symptoms, prescription and over-the-counter medication use, primary care and specialty physician visits in prior three months, and completed the Psychological General Well-Being Scale. For analyses, subjects were classified into four mutually exclusive symptom groups: gastroesophageal reflux disease (GERD) -like, GERD plus motility-like (GERD+), ulcerlike, and motility-like. Of the total sample, 51.4% reported the occurrence of at least one UGIS in the prior three months. Subjects in the GERD+ and ulcer groups used more prescription medications and were more likely to see a physician about the symptoms (P<0.001). Subjects with symptoms demonstrated poorer quality of life compared to subjects with no symptoms. The prevalence of UGIS in the general population is high and symptoms are associated with significant health-care utilization and poorer quality of life.

Prevalence and impact of upper gastrointestinal symptoms in the Canadian population: findings from the DIGEST study

OBJECTIVE: The prevalence and impact of upper gastrointestinal (GI) symptoms in the general population are poorly defined. Most data are obtained from selected samples derived from patients presenting to health care providers. As part of a larger international effort (The DIGEST study), we examined the prevalence of upper GI symptoms among the general Canadian population, as well as their psychosocial and economic impact. METHODS: A sample of 1036 adults was studied, its demographic characteristics closely matching those of the general Canadian population. A validated detailed questionnaire measured the prevalence, severity, and frequency of 15 digestive symptoms, as well as demographic information, use of medication and medical resources, other illnesses, and dietary habits. The Psychological General Well-Being Index, a self-administered questionnaire, assessed the individual’s subjective sense of well-being. RESULTS: Of the sample population, 28.6% reported substantial symptoms in the preceding 3 months, the majority (111/153 subjects) for >1 yr; 34.1% reported having never experienced significant GI symptoms.The most bothersome symptoms were primarily related to dysmotility-like symptoms in 54.9% of those with chronic symptoms, ulcer-like symptoms in 12.4%, and related to heartburn in 42.5%. Chronic upper GI symptoms were associated with a highly significant ( p < 0.001) decrease in all facets of the Psychological General Well Being Index. CONCLUSIONS: Upper GI symptoms are very prevalent in the general Canadian population and substantially affect the quality-of-life and psychological well-being of those affected. Dysmotility-like symptoms, rather than heartburn, are the most common chronic upper gastrointestinal symptoms in the general population.