Factores independientes asociados con el impacto de la enfermedad por reflujo gastroesofágico en la calidad de vida relacionada con la salud / Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life

Introducción: varios factores se han asociado con el deterioro de la calidad de vida en la enfermedad por reflujo gastroesofágico. Sin embargo, se desconoce aquellos que lo condicionan de manera independiente. Objetivo: evaluar los factores independientemente asociados con el impacto de la enfermedad por reflujo gastroesofágico sobre la calidad de vida relacionada con la salud. Material y método: Análisis post hoc de una cohorte prospectiva de pacientes diagnosticados de enfermedad por reflujo gastroesofágico. Se completaron cuestionarios validados para evaluar: calidad de vida (SF36), reflujo gastroesofágico (GERQ) y factores psicológicos (STAI y SCL90R). Resultados: Se incluyeron 98 pacientes. En el análisis univariante, el deterioro en el componente físico del SF36 se encontraba significativamente asociado al sexo femenino, al nivel educativo, a la edad, a la disminución de peso, a la severidad de los síntomas típicos y a los síntomas supraesofágicos e ingresos mensuales; el componente mental se asoció al consumo de alcohol, al dolor epigástrico y a peores puntuaciones en los cuestionarios STAI y SCL90. El análisis multivariante mostró una asociación independiente en el componente físico del SF36 con el nivel educativo (ß = 0,29; p < 0,01), la severidad de los síntomas (ß = -0,38 ; p < 0,001), el índice de masa corporal (ß = -0,30 ; p < 0,005), el estado de ansiedad (ß = 0,28; p < 0,01), el sexo femenino (ß = -0,23; p < 0,05) y la dispepsia (ß = -0,21; p < 0,05); y en la esfera mental, con el estado de ansiedad (ß = -0,39; p < 0,01) y la depresión (ß = -0,32; p < 0,05). Conclusión: los principales factores independientemente asociados con el deterioro de la calidad de vida en pacientes con enfermedad por reflujo gastroesofágico son la severidad de los síntomas típicos y la presencia de dispepsia, con un impacto adicional del índice de masa corporal y el componente psicológico

Background: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. Objective: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. Methods: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). Results: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). Conclusions: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component

Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life.

BACKGROUND: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. OBJECTIVE: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. METHODS: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). RESULTS: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). CONCLUSIONS: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component.

Prevalence and factors associated with faecal impaction in the Spanish old population.

Background: Faecal impaction (FI) is a common problem in old people living in nursing home. Its prevalence and associated factors remain unknown in the general population. Aim: To evaluate FI prevalence in the Spanish population older than 65 years and to assess the factors associated with it. Methods: A telephone survey was carried out of a Spanish population older than 65 years random sample (N = 1000). FI was assessed using a previously validated questionnaire. Results: A total of 28,128 calls were made; 1,431 subjects were eligible and 1,000 subjects were enrollled, mean aged 74.6 ± 7.3 (65­97); 57.5% were women. At least 53 people reported FI within the past year (5.3% (CI 95%: 3.9­6.7%)). Only 0.03% met criteria for chronic constipation and faecal incontinence. FI-associated factors were constipation, female gender, reduced physical activity, and chronic renal failure (CRF). Conclusion: FI is a prevalent problem in old Spanish population. Constipation and female gender are the main associated factors; low physical activity and CRF appear to play also a significant role. Further studies are required to confirm this association.

Non-gastric Gastrointestinal Xanthomas: Case Series and Literature Review.

Gastrointestinal xanthomas are infrequent non-neoplastic lesions characterized by the accumulation of foam cells in the lamina propria. They are commonly seen in association with dyslipidemia, chemotherapy or radiotherapy, and infections in immunosuppressed patients. However, no clear connection to hyperlipidemia has been found. They occur more frequently in the stomach, and are very rare in the small bowel and esophagus. We identified all cases of non-gastric xanthoma or xanthomatosis reported in the English literature by searching the PubMed database and retrospectively reviewed the clinical, endoscopic, and histopathologic features of the 11 cases of non-gastric gastrointestinal xanthomas diagnosed in our hospital. Nine lesions were located in the large bowel, one in the duodenum and one in the esophagus. All xanthomas were small (<5 mm) sessile polyps except the esophageal xanthoma, which measured 13 mm. Two cases in the large bowel and the case in the small bowel were multiple. Most patients with large bowel xanthomas had hypercholesterolemia, unlike esophageal and small bowel cases. The esophageal lesion occurred in a patient with a history of partial fundoplication due to gastroesophageal reflux disease and the small bowel case was associated to chronic atrophic gastritis with intense activity. In our search of the English literature, we found 19 cases of xanthoma or xanthomatosis in the esophagus, 13 cases in the small bowel and 61 cases in the large bowel. In conclusion, gastrointestinal xanthomas, other than the gastric ones, are rare, and are usually incidental findings.

Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva.

INTRODUCTION: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. OBJECTIVE: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. MATERIAL AND METHODS: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. RESULTS: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. CONCLUSIONS: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

Fecal impaction: a systematic review of its medical complications.

BACKGROUND: Fecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis. METHODS: A PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases. RESULTS: 188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5% were over 65 years old, 49% suffered from chronic constipation, 29% had an underlying neuropsychiatric disease and 15% were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4%), on the intestinal lumen (14%) and on adjacent structures (12.6%). CONCLUSIONS: FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

Weight Gain and Somatization are Associated With the Onset of Gastroesophageal Reflux Diseases: Results of Two 5-year Follow-up Studies.

BACKGROUND: Although 2% to 4% of the population develop gastroesophageal reflux disease (GERD) annually, factors associated with the onset of GERD are scarcely known. OBJECTIVE: To assess whether such factors include weight gain and psychological distress. METHODS: Two cohorts (first: N=222; second N=754) drawn from 2 case-control studies were followed up for around 5 years. In 2004, all participants were directly interviewed using a validated questionnaire to collect data on body weight, height, GERD symptoms, and psychological distress. In 2009 to 2010, these same participants were again interviewed using the same methodology. RESULTS: The response rate was 83.3% in cohort 1 and 39.1% in cohort 2, after a follow-up of 4.3±0.7 and 5.6±0.3 years, respectively. The multivariate analysis showed only weight gain and psychological distress as being independently associated with the onset of GERD in both cohorts. Weight gain per kilogram showed an adjusted odds ratio (OR) of 1.21 (1.01-1.44) in the first cohort, and a gain of 5 kg or more showed an adjusted OR of 4.65 (1.72-12.53) in the second. Somatization scores showed an adjusted OR of 1.09 (1.04-1.15) in the first cohort (measured as Minnesota Multiphasic Personality Inventory 2 hypochondriasis score) and 2.88 (1.04-8.02) in the second (measured as psychosomatic symptoms score). Body mass index on attaining overweight or obese status was associated with the onset of GERD in the unadjusted but not in the adjusted analysis. CONCLUSIONS: Weight gain and somatization are the main factors associated with the onset of GERD. The association between GERD and obesity is just the ultimate consequence of gaining weight.

Prevalence and persistence of nausea and vomiting along the pregnancy.

BACKGROUND/AIMS: Nausea and vomiting of pregnancy (NVP) impact in the pregnant woman´s quality of life, especially when are persistent or severe. The objective is to estimate the prevalence and factors associated with the persistence of NVP in each trimester of pregnancy. METHODS: We studied a cohort of 263 pregnant women with gestational age < 12 weeks. Data were collected using the Gastro- Esophageal Reflux Questionnaire validated for use in the Spanish population. Data were collected through telephone interviews at the end of each trimester of pregnancy. The main variable was the presence of NVP in each trimester and their persistence along the pregnancy. RESULTS: The prevalence of nausea in the each trimester was 63.5 %, 33.8 %, 26.2 %, and vomiting was 29.3 %, 22.1 %, 14.1 %, respectively. Factors associated with nausea in the first trimester were Latin-American origin (OR: 3.60, 95 %IC 1.61- 80.5) and primary education (OR: 0.31; 0.13-0.73); vomiting was associated with Latin-American origin (OR: 13.80, 1.82-104.4) and was inversely associated with weight gain (OR: 0.58, 0.35-0.97). Persistence of NVP were only associated with suffering the symptom in the previous trimester (p < 0.01), and did not find other predictor factors. CONCLUSIONS: NVP´s prevalence declines along pregnancy, is associated with race and inversely with weight gain, and its persistence over time cannot be predicted.

A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes.

BACKGROUND: There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people. OBJECTIVE: Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population. DESIGN: Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study. SETTING: 34 randomly selected nursing homes. MEASUREMENTS: The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination. SUBJECTS: Older subjects living in nursing homes. RESULTS: The prevalence of chronic constipation was 70.7% (95%CI: 67.3-74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6-51.0%) and 6.6% (4.7-8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2-18.4]) and uncontrolled constipation (OR: 37.21 [19.7-70.1]), the number of medications (OR: 1.2 [1.1-1.3]), reduced functional capacity (OR: 0.98 [0.97-0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction. CONCLUSIONS: Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.

Classification of adults suffering from typical gastroesophageal reflux disease symptoms: contribution of latent class analysis in a European observational study.

BACKGROUND: As illustrated by the Montreal classification, gastroesophageal reflux disease (GERD) is much more than heartburn and patients constitute a heterogeneous group. Understanding if links exist between patients' characteristics and GERD symptoms, and classify subjects based on symptom-profile could help to better understand, diagnose, and treat GERD. The aim of this study was to identify distinct classes of GERD patients according to symptom profiles, using a specific statistical tool: Latent class analysis. METHODS: An observational single-visit study was conducted in 5 European countries in 7700 adults with typical symptoms. A latent class analysis was performed to identify "latent classes" and was applied to 12 indicator symptoms. RESULTS: On 7434 subjects with non-missing indicators, latent class analysis yielded 5 latent classes. Class 1 grouped the highest severity of typical GERD symptoms during day and night, more digestive and non-digestive GERD symptoms, and bad sleep quality. Class 3 represented less frequent and less severe digestive and non-digestive GERD symptoms, and better sleep quality than in class 1. In class 2, only typical GERD symptoms at night occurred. Classes 4 and 5 represented daytime and nighttime regurgitation. In class 4, heartburn was also identified and more atypical digestive symptoms. Multinomial logistic regression showed that country, age, sex, smoking, alcohol use, low-fat diet, waist circumference, recent weight gain (>5 kg), elevated triglycerides, metabolic syndrome, and medical GERD treatment had a significant effect on latent classes. CONCLUSION: Latent class analysis classified GERD patients based on symptom profiles which related to patients' characteristics. Although further studies considering these proposed classes have to be conducted to determine the reproducibility of this classification, this new tool might contribute in better management and follow-up of patients with GERD.

Prevalence and persistence of nausea and vomiting along the pregnancy / Prevalencia y persistencia de náuseas y vómitos durante el embarazo

Background/aims: Nausea and vomiting of pregnancy (NVP) impact in the pregnant woman’s quality of life, especially when are persistent or severe. The objective is to estimate the prevalence and factors associated with the persistence of NVP in each trimester of pregnancy. Methods: We studied a cohort of 263 pregnant women with gestational age < 12 weeks. Data were collected using the Gastro- Esophageal Reflux Questionnaire validated for use in the Spanish population. Data were collected through telephone interviews at the end of each trimester of pregnancy. The main variable was the presence of NVP in each trimester and their persistence along the pregnancy. Results: The prevalence of nausea in the each trimester was 63.5 %, 33.8 %, 26.2 %, and vomiting was 29.3 %, 22.1 %, 14.1 %, respectively. Factors associated with nausea in the first trimester were Latin-American origin (OR: 3.60, 95 %IC 1.61- 80.5) and primary education (OR: 0.31; 0.13-0.73); vomiting was associated with Latin-American origin (OR: 13.80, 1.82-104.4) and was inversely associated with weight gain (OR: 0.58, 0.35- 0.97). Persistence of NVP were only associated with suffering the symptom in the previous trimester (p < 0.01), and did not find other predictor factors. Conclusions: NVP’s prevalence declines along pregnancy, is associated with race and inversely with weight gain, and its persistence over time cannot be predicted (AU)

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Influence of psychological distress on characteristics of symptoms in patients with GERD: the role of IBS comorbidity.

UNLABELLED: A link between gastroesophageal reflux disease (GERD) and psychological distress has been suggested; psychological factors may modulate the characteristics of symptoms. Besides, irritable bowel syndrome (IBS) frequently coexists with GERD so it may be hypothesized that psychological distress in GERD might be an epiphenomenon of IBS comorbidity. AIMS: Evaluate the association of psychological distress with GERD, the influence of psychological factors on symptoms, whether psychological distress is explained by a subset of GER patients, and if coexistence with IBS would be a surrogate marker. METHODS: We performed a prospective case-control study. Cases were patients diagnosed with GERD reporting heartburn at least 2 days per week as the main complaint. Controls were matched healthy subjects without or occasional symptoms. All individuals completed a set of validated questionnaires to evaluate GERD and IBS symptoms and psychological distress (SCL-90R). RESULTS: Ninety-two patients and 92 controls were included. Fifty-seven patients and six controls fulfilled Rome II criteria for IBS. Body mass index (BMI), somatization, and IBS were independently related to GERD. Patients with and without IBS were not different in any measure of psychological distress. Characteristics of symptoms did not correlate to psychological measures. Cluster analysis isolated a cluster of nondistressed from distressed subjects. A higher proportion of GERD patients than controls were classified as distressed (29.7% versus 7.7%). No variable (including IBS) distinguished nondistressed from distressed GERD patients, except for sex. CONCLUSIONS: Nearly one-third of GERD patients attending a gastroenterologist office are psychological distressed; they cannot be identified by features of symptoms or IBS comorbidity so a specific anamnesis under the scope of a biopsychosocial model is warranted.

Determinants of quality of life in irritable bowel syndrome.

OBJECTIVES: Health-related quality of life (HRQOL) is a main outcome in irritable bowel syndrome (IBS), but most studies have been conducted on moderate-severe patients. We sought to ascertain the relative contribution of severity, anxiety, and personality to impairment of HRQOL in a sample representative of the entire IBS spectrum. MATERIALS AND METHODS: IBS consulters, IBS nonconsulters, and controls were invited to complete questionnaires designed to measure severity of IBS (Functional Bowel Disease Severity Index), anxiety (State-trait Anxiety Inventory), personality (Minnesota Multiphasic Personality Inventory-2), and HRQOL [Short Form 36 (SF-36)]. The SF-36 scores of the study groups were compared, and a multiple regression model was constructed. RESULTS: Sixty-six IBS consulters, 70 nonconsulters, and 117 controls were studied. All 3 groups differed in terms of SF-36 physical (46.5+/-9.4 vs. 50.5+/-8.0 vs. 54.5+/-6.0) and mental composite scores (38.2+/-12.5 vs. 43.2+/-12.0 vs. 46.7+/-10.6). Although physical scores were linked to hypochondriasis (beta=-0.39; P<0.001), severity of pain (beta=-0.28; P<0.001), and age, mental scores were associated with state anxiety (beta=-0.36; P<0.001) and trait anxiety (beta=-0.40; P<0.001). CONCLUSIONS: HRQOL is impaired in all subgroups of IBS sufferers, with the degree of impairment depending mostly on symptom severity and psychologic factors (hypochondriasis and anxiety).

Gastroesophageal reflux symptoms during and after pregnancy: a longitudinal study.

BACKGROUND AND AIMS: Prevalence of gastroesophageal reflux symptoms (GERS) increases during pregnancy, but there are no longitudinal studies on western populations examining their incidence in each trimester. Our aim was to describe the natural history of GERS in pregnancy and to ascertain whether pregnancy might be associated with a higher risk of developing GERS 1 yr postpartum. METHODS: Pregnant women (<12 wk gestation) and age-matched controls were included. A telephone survey was conducted, covering pregnant women at 12, 24, and 36 wk of gestation and at 1 yr postpartum, using a validated questionnaire. Controls were interviewed at baseline and 21 months later. RESULTS: Data on 263 pregnant women were analyzed. Incidence of GERS was 25.8% (95% confidence interval [CI] 20.1-31.1%) in the first trimester, 24.3% (95% CI 18.1-30.6%) in the second, and 25.5% (95% CI 18.2-32.8%) in the third. Factors associated with developing GERS in the first trimester were South American origin (odds ratio [OR] 2.75, 95% CI 1.30-5.84) and prepregnancy occasional GERS (OR 3.00, 95% CI 1.35-6.66). Risk factors of GERS in the third trimester were cumulative weight gain during pregnancy (OR 1.18, 95% CI 1.04-1.32) and prepregnancy occasional GERS (OR 3.79, 95% CI 1.08-13.24). Incidence of frequent GERS at 1 yr postpartum was higher in pregnant versus control women (4.7%vs 1.3%, P < 0.05). CONCLUSIONS: Incidence of GERS is similar across the three trimesters of pregnancy. Accumulated weight gain during pregnancy is associated with a higher risk of GERS in the third trimester. Pregnancy might constitute a risk factor for developing GERS 1 yr postpartum.