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Chong VH, Wang CL
Correspondence: Dr Chong Vui Heng, email@example.com
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 (5.1 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 CI 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.
Keywords: dyspepsia, endoscopy, heartburn, rheumatoid arthritis, systemic lupus erythromatosus
Singapore Med J 2008; 49(5): 419-424