Epidemiological study on the incidence of gastroesophageal reflux disease symptoms in patients in acute treatment with NSAIDs

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Date: Jan. 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 4,407 words
Lexile Measure: 1220L

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Author(s): Carlos Martín-de-Argila [*] 1 , Pedro Martínez-Jiménez 2

Keywords

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antisecretory agents and antacids; gastroesophageal reflux disease; NSAID; patients' related quality of life; proton pump inhibitor

Gastroesophageal reflux disease (GERD) is one of the most common disorders in medical practice [1] . According to the Montreal definition and classification [2,3] , GERD is a condition that appears when the stomach content reflux causes troublesome symptoms and/or complications.

The lack of validated criteria for the diagnosis of GERD makes it difficult to estimate its prevalence. When defined as at least weekly heartburn and/or acid regurgitation, the prevalence of GERD in Western countries ranges between 10 and 20% [4] . There are inconsistencies between reports, possibly related to geographical and behavioral variations as well as methodological differences [5] . In Spain, the prevalence has been reported to be 15% [6] .

GERD is associated with esophageal (heartburn being the main symptom) [3] and extraesophageal manifestations (such as chronic cough, laryngitis, asthma or chest pain) [7] ; and with a negative impact on patients' related quality of life [8] . In addition, chronic GERD is associated with complications, such as Barrett's metaplasia and esophageal cancer [9] .

Several behavioral risk factors have been related with the development of GERD, such as smoking, coffee intake, alcohol consumption, as well as the use of medication, such as NSAIDs, including acetylsalicylic acid (ASA) [4,10] . However, although NSAIDs are reported to induce mucosal injury, the information on the mechanism involved in this process is limited [11] . Aspirin increases the risk of peptic ulcer through the inhibition of gastrointestinal (GI) mucosal COX-1. It has been suggested that NSAIDs may act by increasing the duration of acid reflux [12] .

Among the behavioral risk factors thought to trigger GERD symptoms, the most investigated has been cigarette smoking and coffee consumption. There are several studies showing a significant relationship between GERD and tobacco use [4] . However, for coffee and alcohol consumption the data are less clear and controversial.

NSAIDs are commonly used in the treatment of pain, inflammation and fever. In addition, ASA is routinely used as a prophylaxis therapy for cardiovascular events [13] . The use of NSAIDs, including ASA, is considered a significant risk factor for GERD [10] ; and in patients with pre-existing GERD, NSAIDs can worsen symptoms [14] . The concomitant use of low-dose ASA with any NSAID may increase the risk of GI complications [15] . Upper GI symptoms, if untreated, can decrease patients' related quality of life, and lead to treatment discontinuation [14,16] .

Among other antisecretory agents/antacids, proton pump inhibitors (PPIs) have demonstrated effectiveness in preventing and healing upper GI ulcers associated with nonselective NSAIDs [14] .

The objective of this study was to assess GERD characteristics and the association between the use of NSAIDs (including ASA) and GERD symptoms, as well as to evaluate the risk factors for GERD and the use of antisecretory agents/antacids in relation to the NSAIDs prescribed and the related symptoms.

Patients & methods

This multicenter, cross-sectional, retrospective and noninterventional study was performed in 434 Spanish primary-care centers from March 2008 to June 2008. To reach the estimated sample...

Source Citation

Source Citation   

Gale Document Number: GALE|A312892145