Türkiyede İrritabl Barsak Sendromunun Gastroösofajeal Reflu Şikayeti Olan Hastalardaki Birlikteliği ve Muhtemel Etkenleri
Özet
Background and Aims: GastroEsofageal Reflux Disease (GERD) being one of the
most common gastrointestinal disorders, its prevalence varies from one community to
another. The symptoms of GERD may occur in any person but if GERD related symptoms
are happening at least once a week GERD can be considered. The most common
symptoms are the presence of frequent heartburn or acid regurgitation. Irritable Bowel
Syndrome can occur at the same time with GERD, The prevalence of the irritable bowel
syndrome (IBS), defined as discomfort or pain specifically associated with an abnormal
bowel habit, is reported to be approximately 10% in the general population. It is more
common in females and usually is associated (in about 29-90% of cases) with functional
gastro intestinal disorders. Materials and Methods: The study was carried out in a
population of patients selected among those admitted to Gastroenterology poly clinic
complaining of GERD related symptoms and people who had no known illness and came
to the blood bank for blood donation and when questioned they was found to have GERDrelated
symptoms. The prevalence and epidemiologic features of gastroesophageal reflux
disease were investigated via face-to-face questionnaire to a total of 217 randomly selected
patients from both of the groups. The diagnosis of gastroesophageal reflux disease was
based on the validated questionnaire which was tested and published by Ege University
Gastroenterology department. The diagnosis of IBS was based on Rome III criteria and the
criteria of The World Gastroenterology Organisation. The aim of the study is to asses
Irritable Bowel Syndrome frequency in Turkish Gastroesofageal Reflux Disease patients
with possible causes and clinicopathological associations. Findings: 35% of subjects
(n=76) were male and 65% were female (n=141) and the average age was 38 years (s.d.
10.03). The most common complaint was asid regurgitation (93.5%, n=203) and heartburn
(82%, n=178). 70% of subjects (95% CI: 64-76) had İBS (females 73%, n=104, and males
63.2%, n=48). Subjects who had İBS symptoms was found to have higher GERD Typical
Symptom Score (TySS 7.11 versus 4.28, mean difference 2,83, 95% CI: 1,98 - 3,77, p
value = 0.005) and higher Total Reflux Score (TRS 17 versus 11.8, mean difference 5,2,
95% CI: 3,5-7,1, p value < 0.001). GERD TRS was higher in people taking certain fooddrink
types, among these food-drink types are tea and coffee (TRS 17.14 versus 13.78, p
value < 0.001), cola drinks (TRS 16.38 versus 13.97, p value < 0.05), fatty food (TRS
16.35 versus 13.11, p value < 0.05) and strong sweats (TRS 17.21 versus 14.57, p value <
0.05). Patients who described increase in reflux symptoms with stress and anxiety (n=188)
mostly also had sleep disturbances (97.3%, n=183, p < 0.001), mean TRS of these patients
was 16.26 versus 10.72 in those who had no problem with stress or anger (no anxiety). No
statistically significant effect of smooking was found on Reflux symptoms. H pylori
eradication history was associated with higher reflux scores (18.08 versus 14.22, p value <
0.001). No statistically significant difference was found between those who had IBS and
those who didn’t regarding age, sex, body mass index, multiple hospital visits, strong
sweat or spicy food intake, H pylori eradication history, proton pump inhibitor use and
smoking. NSAID use was associated with higher coincidence of IBS (84.6% with NSAID
use and 61.9% in absence of NSAID, correlation: 0.238, %95 CI: 0.108-0.369, p value <
vi
0.001). alcohol use didnot significantly affect TRS and in the same time it was associated
with lower prevalence of IBS (24% in those who use small amounts of alcohol 1-2 times
per week versus 76% in non users) and when we did binary logistic regression analysis use
of small amounts of alcohol was associated with lower risk of IBS (Relative Risk 0.059,
%95 CI: 0.01-0.337, p = 0,001), but we should note that only 25 patints (%11.5) described
alcohol use and all of them was drinking alcohol no more than 1-2 times a week. In
addition to NSAID other factors showed positive correlation with IBS and these included
tea-coffe (89% associated with IBS versus 62% in those not using them, correlation:
0.232, 95% CI: 0.102-0.363, p value < 0.001), cola drinks (79% associted with IBS versus
52.8%, correlation: 0.265, %95 CI: 0.135-0.395, p value < 0.001), fatty food (75.8%
associted with IBS versus %53.6, correlation: 0.212, 95% CI: 0.81-0.343, p value < 0.05).
Patients who described increase in reflux symptoms with stress and anger and who mostly
also had sleep disturbances (n=188) had higher GERD & IBS overlap (74.5% versus
41.4%, correlation: 0.246, 95% CI: 0.115-0.376, p value 0.001). 17.5% of GERD patints
(n=37) had fibromyalgia. Those with or without fibromyalgia had no stastically significant
difference regarding age, sex and association with IBS. Patients with family history of
reflux had higher TRS values (16.84 versus 13.89, p value < 0.001) and higher incidence
of IBS (75.9% versus 62.6%, correlation: 0.144, 95% CI: 0.010-0.278, p value < 0.05). We
also noted that some atypical GERD symptoms are associated with increased risk of IBS
development, these symptoms include belching (in no IBS group %43,1 n=28 and in IBS
group %75 n=114), nausea (in no IBS group %46,2 n=130, and in IBS group %80,9
n=123) and hoarseness of voice (in no IBS group %9,2 n=6 and in IBS group %50,7
n=77). To see the effects of these factors independent from each other we did binary
logistic regression analysis and we found that cola drinks (Relative Risk 4.65 %95 CI:
1.45-14.9, p 0.01), excessive belching (Relative Risk 3.79, %95 CI: 1.25-11.5, p = 0.01),
prolonged periods of nausea (Relative Risk 4.56, %95 CI: 1.62-12.87, p < 0,01) and
hoarseness of voice (Relative Risk 10.54, %95 CI: 2.65-41.9, p = 0,001) are associated
with increased risk of IBS association. Results: IBS can be associated with GERD in men
and women and if so it is usually associted with increased GERD symptoms severity and
frequency. Some factors can increase the risks of association between GERD and IBS, in
our study the most important factors are cola drinks, presence of belching and nausea and
regurgitation and hoarseness of voice. Other factors that might contribute to increased IBS
association with GERD are NSAID use, coffee, tea and fatty meal consumption in addition
to anxiety and sleep disturbances. Family history of reflux is also associated with more
GERD symptoms and with increased IBS association.