Higher prevalence of gastrointestinal symptoms among patients with rheumatic disorders
Chong, V.H.; Wang, C.L.
Singapore Medical Journal 49(5): 419-424
2008
ISSN/ISBN: 0037-5675 PMID: 18465055 Document Number: 618570
Introduction: Chronic disorders, such as rheumatic disorders, are associated with increased gastrointestinal (GI) complaints. Medications may be a contributory factor. This study assessed the prevalence of GI symptoms among patients followed-up in a rheumatology clinic.Methods: Enquiries about GI, psychological and psychosomatic symptoms (headache, insomnia, anxiety, backache and depression) were made from patients. Non-related visitors served as the control group. The underlying disorders were rheumatoid arthritis (RA, 37 percent), systemic lupus erythromatosus (SLE, 23 percent) and others (40 percent).Results: The symptom prevalence of the following complaints were: reduced appetite (10.2 percent), nausea (20.2 percent), vomiting (10.7 percent), dysphagia (7.3 percent), odynophagia (S. I percent), early satiety (27.5 percent), heartburn (15.2 percent), dyspepsia (44.6 percent), abdominal bloating (20.8 percent) and irregular bowel habit (6.7 percent). There were no differences between the various rheumatic disorders (RA/SLE and RA/others) except for more heartburn in SLE compared to others (p-value is less than 0.05). There was no significant difference between nonsteroidal anti-inflammatory drug (NSAID) users and non-users. Patients on medications with GI (disease modifying/steroid/NSAIDs) adverse effects, experienced a higher rate of early satiety (odds-ratio [OR] 3.5,95 percent confidence interval [CI] 1.4-8.9) and dyspepsia (OR 2.1, 95 percent Cl 1.2-4.3). Compared to the control group, patients had more GI symptoms (all p-values are less than 0.05) except for irregular bowel habits. Patients also experienced more anxiety (OR 2.1,95 percent CI 1.1-2.4) and backache (OR 2.6, 95 percent CI 1.6-4.2), and had significantly higher symptom clustering (more than two symptoms) compared to the controls (p-value is less than 0.001).Conclusion: GI symptoms are common among patients with rheumatic disorders. Medications alone do not account for the high prevalence, suggesting that the underlying conditions predispose to GI symptoms.