Clinical profiling of patients with Acid Peptic Disorders (APD) in India: a cross-sectional survey of clinicians

Authors

  • Ramesh Roop Rai Rai Specialty Care Centre, Jaipur, H-6, Janpath, Shyam Nagar, Jaipur, Rajasthan, India
  • A. Gangadhar Abbott Healthcare Pvt Ltd, Mumbai, Maharashtra, India
  • Mayur M. Mayabhate Abbott India Limited, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20164779

Keywords:

Alarming symptoms, GERD, Heartburn, Overlapping conditions

Abstract

Background: Acid peptic disorders (APD) which include GERD and peptic ulcer disease (PUD) are common conditions reported in daily clinical practice. This survey aimed to understand the epidemiology, clinical presentation and associated overlapping comorbidities in Indian patients with APD.

Methods: This was an interview based cross-sectional survey of 1000 clinicians (specialist gastroenterologists and non-specialists) across India who treated patients of APD in their practice. Information related to patient demographics, diagnosis and clinical presentation (common symptoms and their duration, alarming, lower GI and extra-esophageal symptoms) were assessed. Indications for upper GI endoscopy, esophageal pH monitoring and esophageal manometry were also collected. Descriptive analyses were done.

Results: About 39.2% and 37.1% patients had reported GERD and PUD respectively (duodenal ulcer: 10.5%, gastric ulcer: 9.9% and peptic ulcer-non-specified: 16.7%); 25.2% patients were reported to have non-ulcer dyspepsia. Heartburn was the most common symptom in GERD (60.5%); epigastric pain was common in PUD (72.3%); 49% GERD patients presented with alarming symptoms, mainly dysphagia (67%), whereas for PUD, GI bleeding was the most common alarming symptom (47.6%). Profiles of patients visiting clinicians were similar with respect to the presenting symptoms and associated conditions. Functional dyspepsia (25.9%), constipation (23.4%) and irritable bowel syndrome (23.4%) were the most common overlapping conditions associated with both GERD and PUD.

Conclusions: APD (GERD and PUD) was more common in 18-59 yrs. age group with heart burn as the common symptom for GERD and epigastric pain for PUD. Diagnosis was mostly based on clinical symptoms; nearly 50% patients of APD presenting with alarming symptoms needed prompt endoscopy. Thus, there is need to focus on these overlapping disorders while managing patients of APD.

References

Shin JM, Vagin O, Munson K, Kidd M, Modlin IM, Sachs G. Molecular mechanisms in therapy of acid-related diseases. Cell Mol Life Sci. 2008;65(2):264-81.

Dutta AK, Chacko A, Balekuduru A, Sahu MK, Gangadharan SK. Time trends in epidemiology of peptic ulcer disease in India over two decades. Indian J Gastroenterol. 2012;31(3):111-5.

Bhatia SJ, Reddy DN, Ghoshal UC. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011;30(3):118-27.

Rameschandra S, Acharya V, Kunal, Vishwanath T, Ramkrishna A, Acharya P. Prevalence and Spectrum of Gastro Esophageal Reflux Disease in Bronchial Asthma. J Clin Diagn Res. 2015;9(10):OC11-4.

Boeckxstaens GE, Rohof WO. Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2014;43(1):15-25.

Sung JJY, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009;29(9):938-46.

Aro P, Storskrubb T, Ronkainen J. Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study. Am J Epidemiol. 2006;163(11):1025-34.

Mohiuddin MK, Chowdavaram S, Bogadi V. Epidemic Trends of Upper Gastrointestinal Tract Abnormalities: Hospital-based study on Endoscopic Data Evaluation. Asian Pac J Cancer Prev. 2015;16(14):5741-7. http://www.ncbi.nlm.nih.gov/pubmed/26320445. Accessed March 1, 2016.

Singh VK, Kathiresan P, Kathiresa NP, Singh PK. Prescribing pattern of acid suppressants in modern clinical practice- An analysis. Pharm Sin. 2011;2(3):67-73.

Moayyedi P, Hunt R, Armstrong D, Lei Y, Bukoski M, White R. The impact of intensifying acid suppression on sleep disturbance related to gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2013;37(7):730-7.

Mejia A, Kraft WK. Acid peptic diseases: pharmacological approach to treatment. Expert Rev Clin Pharmacol. 2009;2(3):295-314.

Xia B, Xia HHX, Ma CW. Trends in the prevalence of peptic ulcer disease and Helicobacter pylori infection in family physician-referred uninvestigated dyspeptic patients in Hong Kong. Aliment Pharmacol Ther. 2005;22(3):243-9.

Haruma K, Kamada T, Oosawa M, Murao T, Shiotani A. [Acid related diseases--comparison between western countries and Japan]. Nihon Rinsho. 2015;73(7):1081-5. http://www.ncbi.nlm.nih.gov/pubmed/26165061. Accessed June 24, 2016.

Furuta K, Kinoshita Y. [Relationship of acid-related diseases with lifestyle habit changes and environmental factors]. Nihon Rinsho. 2015;73(7):1086-92. http://www.ncbi.nlm.nih.gov/pubmed/26165062. Accessed June 24, 2016.

Thrift AP, Kramer JR, Qureshi Z, Richardson PA, El-Serag HB. Age at onset of GERD symptoms predicts risk of Barrett’s esophagus. Am J Gastroenterol. 2013;108(6):915-22.

Petersen H, Kristensen P, Johannessen T, Kleveland PM, Dybdahl JH, Myrvold H. The natural course of peptic ulcer disease and its predictors. Scand J Gastroenterol. 1995;30(1):17-24. http://www.ncbi.nlm.nih.gov/pubmed/7701245. Accessed March 6, 2016.

Triadafilopoulos G. Endoscopic Options for Gastroesophageal Reflux: Where Are We Now and What Does the Future Hold? Curr Gastroenterol Rep. 2016;18(9):47.

Bărboi OB, Prelipcean CC, Mihai C. Extra digestive manifestations of gastroesophageal reflux disease: demographic, clinical, biological and endoscopic features. Rev medico-chirurgicală̆ a Soc Medici ş̧i Nat din Iaş̧i. 2016;120(2):282-7.

Roman S, Holloway R, Keller J. Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry. Neurogastroenterol Motil. 2016.

Herbella F, Andolfi C, Vigneswaran Y, Patti M, Pinna B. Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study. J Gastrointest Surg. 2016.

Quigley EMM. Non-erosive reflux disease, functional heartburn and gastroesophageal reflux disease; insights into pathophysiology and clinical presentation. Chin J Dig Dis. 2006;7(4):186-90.

Najm WI. Peptic ulcer disease. Prim Care. 2011;38(3):383-94.

Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med. 2010;123(4):358-66.

Katz PO, Gerson LB, Vela MF. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2013;108(3):308-28.

An JH, Kim SG. L-carnitine supplementation in hypothyroidism [Letter to the Editor]. Endocr J. 2016;63(10):939-40.

Kim BW. [Diagnosis and Treatment of Peptic Ulcer Disease: Present and Future Perspective]. Korean J Gastroenterol. 2016;67(6):318-20.

Wilson JL, Pruett KL. Gastroesophageal Reflux Disease: Treating Wisely. N C Med J. 2016;77(3):202-205.

Bortoli N de. Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World J Gastroenterol. 2013;19(35):5787.

Sun H, Yi L, Wu P. Prevalence of Gastroesophageal Reflux Disease in Type II Diabetes Mellitus. Gastroenterol Res Pract. 2014;(601571):1-4.

Shiao TH, Liu CJ, Luo JC. Sleep apnea and risk of peptic ulcer bleeding: a nationwide population-based study. Am J Med. 2013;126(3):249-55.

Qu Y, Ye JY, Han DM. Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease. Chin Med J (Engl). 2015;128(16):2162-7.

Downloads

Published

2016-12-24

How to Cite

Rai, R. R., Gangadhar, A., & Mayabhate, M. M. (2016). Clinical profiling of patients with Acid Peptic Disorders (APD) in India: a cross-sectional survey of clinicians. International Journal of Basic & Clinical Pharmacology, 6(1), 194–202. https://doi.org/10.18203/2319-2003.ijbcp20164779

Issue

Section

Original Research Articles