Nonsteroidal antiinflammatory drugs and dyspepsia in general practice – a prospective, controlled study
Background: Treatment of dyspeptic patients is a diagnostic and therapeutic problem frequently encountered by general and family practitioners, by internists and gastroenterologists.
Aims: In our study we attempted to assess the prevalence of dyspeptic symptoms in patients over 60 who are regular users of nonsteroidal antiinflammatory drugs.
Patients and methods: This is a prospective cohort study based on an interview during examination in the OPC, the results obtained by the diagnostic procedures and follow-up. It was carried out between 1999 and 2003 at a family practitioner’s and a gastroenterologic OPC. In patients who were regular users of nonsteroidal antiinflammatory drugs, we established the prevalence of dyspeptic symptoms, the most often used drugs and the type of diagnostic procedure applied to define the cause of dyspepsia. The control group was composed of patients over 60 who were also exhibiting dyspeptic symptoms but not using any NSAID.
Results: The study comprised 50 patients, 27 women and 23 men, the mean age was 67.3 years, the range 60–80 years. The control group comprised 50 patients, 28 women and 22 men, the mean age was 66.6 years, the range 61–80 years. All patients of the study group had used NSAR or preparations of acetylsalicylic acid during the past 3 months. There were no statistically significant differences between the patients of both groups as regards the number and use of other drugs, p = 0.65. The average score of dyspeptic complaints in our study group was 3.02, SD ± 0.6, and 70% of patients wished to use H2 antagonists or proton pump inhibitors for these complaints. In patients of the control group, the average score of complaints was 2.72, SD ± 0.7, and they also took drugs for the alleviation of their complaints more rarely.
Conclusions: Nonsteroidal antiinflammatory drugs belong among the important causes of dyspepsia in the elderly. When making decisions about the various diagnostic procedures for defining the etiology of dyspepsia, we must be guided by a good knowledge of the symptoms as well as of our patients.
Skok P. Funkcionalne bolezni prebavil – najpogostejši simptomi in znaki. Gastroenterolog 2003; 7(2): 6–9.
Wingate D, Hongo M, Kellow J, Lindberg G, Smout A. Disorders of gastrointestinal motility. J Gastroenterol Hepatol 2002; 17: Suppl 1: S1–S14.
Bennet EJ, Evans P, Scott AM, et al. Psychological and sex features of delayed gut transit in functional disorders. Gut 2000; 46: 83–7.
Holzer P, Schicho R, Holzer-Petsche U, Lippe IT. The gut as a neurological organ. Wien Klin Wochenschr 2001; 113: 647–60.
Reynolds JC. Prokinetic agents: A key in the future of gastroenterology. Gastroenterol Clin North A 1989; 18: 437–57.
Gilja OH, Hausken T, Odegaard S, Berstad A. Three–dimensional ultrasonography of the gastric antrum in functional dyspepsia. Scand J Gastroenterol 1996; 31: 847–55.
Wald A. Colonic and anorectal motility testing in clinical practice. Am J Gastroenterol 1994; 89: 2109–15.
Quartero AO, de Witt NJ, Lodder AC, et al. Disturbed solid-phase gastric emptying in functional dyspepsia: a meta analysis. Dig Dis Sci 1998; 43: 2028–33.
Markovič S. Funkcionalne bolezni prebavil. In: Kocijančič A, Mrevlje F eds. Interna medicina. Ljubljana: EWO, DZS, 1998: p. 419–22.
Hungin AP, Rubin GP, Russell AJ, Convery B. Guidelines for dyspepsia management in general practice using focus groups. Br J Gen Pract 1997; 47: 275–9.
Heikkinen M, Pikkarainen P, Takala J, Rasanen H, Julkunen R. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol 1995; 30: 519–23.
Holtman G, Talley NJ. Clinician’s manual on managing dyspepsia. London: Life Science Communications, 2000: p. 1–88.
Gerards C, Leodolter A, Glasbrenner B, Malfertheiner P. H. pylori infection and visceral hypersensitivity in patients with irritable bowel syndrome. Dig Dis 2001; 19: 170–3.
Barbara L, Camilleri M, Corinaldesi R, et al. Definition and investigation of dyspepsia – consensus of an ad hoc international working party. Dig Dis Sci 1989; 34: 1272–6.
Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ 1989; 298: 30–2.
Johanessen T, Petersen H, Klevell PM, et al. The predictive value of history in functional dyspepsia. Scand J Gastroenterol Suppl 1990; 25: 689–97.
Richter JE. Dyspepsia: Organic causes and differential characteristics from functional dyspepsia. Scand J Gastroenterol Suppl 1991; 182: 11–6.
Richter JE. Stress and psychologic and environmental factors in functional dyspepsia. Scand J Gastroenterol Suppl 1991; 182: 40–6.
Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology 1992; 102: 1259–68.
Talley NJ. Functional dyspepsia - should treatment be targeted on disturbed physiology? Aliment Pharmacol Ther 1995; 9: 107–15.
Camilleri M. Nonulcer dyspepsia: a look into the future. Mayo Clin Proc 1996; 71: 614–22.
Malagelada JR. Functional dyspepsia – insights on mechanism and management strategies. Gastroenterol Clin North Am 1996; 25: 103–12.
O’Morain C, Buckley M. Helicobacter pylori and dyspepsia. Scand J Gastroenterol Suppl 1996; 214: 28–30.
Christie J, Shepherd NA, Codling BW, Valori RM. Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia. Gut 1997; 41: 513–7.
Axon ATR. Chronic dyspepsia: Who needs endoscopy? Gastroenterology 1997; 112: 1376–80.
Fisher RS, Parkman HP. Management of nonulcer dypepsia. N Engl J Med 1998; 339: 1376–81.
Veldhuyzen van Zanten SJO, Cleary C, Talley NJ, Peterson TC, Nyren O, Bradley LA, et al. Drug treatment of functional dyspepsia: a systematic analysis of trial methodology with recommendation for design of future trials. Am J Gastroenterol 1996; 91: 660–73.
Dobrilla G, Comberlato M, Steele A, Vallaperta P. Drug treatment of functional dyspepsia – a meta analysis of randomized controlled clinical trials. J Clin Gastroenterol 1989; 11: 169–77.
Armstrong D. Helicobacter pylori and dyspepsia. Scand J Gastroenterol Suppl 1996; 215: 38–47.
Small PK, Loudon MA, Waldron B, Smith A, Campbell FC. Importance of reflux symptoms in functional dyspepsia. Gut 1995; 36: 189–92.
Jones R. What happens to patients with non ulcer dyspepsia after endoscopy. Practitioner 1988; 232: 75–6.
Lawson JM. Predicting endoscopic diagnosis in the dyspeptic patient: untying a Gordian knot. Gastrointest Endosc 1997; 46(6): 583–4.
Wisniewski RM, Peura DA. Helicobacter pylori: beyond peptic ulcer disease. Gastroenterologist 1997; 5(4): 295–305.
Bytzer P, Hansen JM, Schaffalitzky-de-Muckadell OB, Malchow-Moller A. Predicting endoscopic diagnosis in the dyspeptic patient. The value of predictive score models. Scand J Gastroenterol 1997; 32(2): 118–25.
Ebell MH, Warbasse L, Brenner C. Evaluation of the dyspeptic patient: a cost-utility study. J Fam Pract 1997; 44(6): 545–55.
Hungin AP, Rubin GP, Russell AJ, Convery B. Guidelines for dyspepsia management in general practice using focus groups. Br J Gen Pract 1997; 47(418): 275–9.
Grainger SL, Klass HJ, Rake MO, Williams JG. Prevalence of dyspepsia: the epidemiology of overlapping symptoms. Postgrad Med J 1994; 70(821): 154–61.
Verhaeghe J, Jaecques N, Rombouts J, Spaepan W, Cardon E, Lebrun F, et al. Functional dyspepsia versus other functional gastrointestinal disorders: a practical approach in Belgian general practices. Scand J Gastroenterol Suppl 1993; 195: 25–34.
Hallas J, Bytzer P. Screening for drug related dyspepsia: an analysis of prescription symmetry. Eur J Gastroenterol Hepatol 1998; 10(1): 27–32.
Kuykendall DH, Rabeneck L, Campbell CJ, Wray NP. Dyspepsia: how should we measure it? J Clin Epidemiol 1998; 51(2): 99–106.
Whitaker MJ, Brun J, Carelli F. Controversy and consensus in the management of upper gastrointestinal disease in primary care. The International Gastro Primary Care Group. Int J Clin Pract 1997; 51(4): 239–43.
Hafeiz HB, al-Quorain A, al-Mangoor S, Karim AA. Life events stress in functional dyspepsia: a case control study. Eur J Gastroenterol Hepatol 1997; 9(1): 21–6.
Voutilainen M, Sipponen P, Mecklin JP, Juhola M, Farkkila M. Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion 2000; 61: 6–13.
Skok P, Križman I, Čeranič D, Skok M. Reflux disease and Helicobacter pylori eradication – a prospective, controlled study. Gut 2001; 49 Suppl III: 1147.
Skok P, Križman I, Skok M. Endoscopy, 24-hour pH-metry and bilimetry in reflux esophagitis – results of a prospective, controlled study. Gut 2002; 51 Suppl III: A230.
Skok P, Križman I, Skok M. Krvaveča peptična razjeda, nesteroidna protivnetna zdravila in okužba s Helicobacter pylori – prospektivna, kontrolirana, randomizirana raziskava. Zdrav Vestn 2002; 71: 357–62.
Barr M, Buckley M, O’Morain C. Review article: non-steroidal anti-inflammatory drugs and Helicobacter pylori. Aliment Pharmacol Ther 2000;14 Suppl 3: 43–7.
Santolaria S, Lanas A, Benito R, Perez-Aisa M, Montoro M, Sainz R, et al. Helicobacter pylori infection is a protective factor for bleeding gastric ulcers but not for bleeding duodenal ulcers in NSAID user. Aliment Pharmacol Ther 1999; 13(11): 1511–8.
Kocijančič B, Ivanuša M. Gastroezofagealna refluksna bolezen pri odraslih. Zdrav Vestn 2000; 69: 531–6.
Pleterski G, Ivanuša M, Drinovec J, Mrhar A. Epidemiološka ocena pogostnosti gastroezofagealne refluksne bolezni za Slovenijo. Zdrav Vestn 2002; 71: 379–84.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.