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Symptomatic Gastroesophageal Reflux in Acutely Hospitalized Patients

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Abstract

Patients admitted acutely to hospital may be atrisk of increased morbidity and mortality as a result ofgastroesophageal reflux and its complications. Therecognized association of gastroesophageal reflux with cardiac and respiratory disease, the useof drugs that reduce lower esophageal sphincterpressure, and the supine position in which many patientsare nursed may increase the risk of gastroesophageal reflux. This study aimed to determine theprevalence and severity of refluxlike symptoms in aseries of consecutive unselected patients admittedacutely through the accident and emergency department of a district general hospital and to study theeffect of hospitalization on these symptoms. Patientswere interviewed by questionnaire on two occasions:immediately following admission and again 7-10 days later. The frequency of symptoms of heartburn,acid regurgitation, dysphagia, nausea, and belching wererecorded on a 6-point scale, in addition to whetherthese symptoms occurred at night. Medication history, the number of days spent on bed rest,nasogastric intubation, and operation history were alsorecorded. In all, 275 patients were interviewed, of whom229 had a second interview; 27% (62) had symptoms at least once a week (49% reported symptoms atleast once a month) prior to admission, of whom 4% (9)had daily heartburn and/or acid regurgitation. Followingadmission to hospital there was a significant (P < 0.001) fall in the prevalence andfrequency of refluxlike symptoms. There was asignificant association of refluxlike symptoms withnumber of days spent in bed (P < 0.05) and with theuse of nonsteroidal antiinflammatory drugs in hospital(P < 0.0001). Logistic regression analysis confirmedthe association of NSAIDs with refluxlike symptoms.Nasogastric intubation and surgery were not associated with heartburn. In conclusion, symptoms ofheartburn and acid regurgitation become less frequentfollowing admission to hospital. This probably relatesto a reduction in physical exertion following hospital admission but may reflect a reduction inanxiety levels or treatment of underlying disease.Patients on prolonged bed rest and those givennon-steroidal anti-inflammatory drugs are at increasedrisk of refluxlike symptoms and may require antirefluxmeasures.

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Authors
  1. Magda Newton
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  2. Michael A. Kamm
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  3. Tracey Quigley
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  4. W. Rodney Burnham
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Newton, M., Kamm, M.A., Quigley, T. et al. Symptomatic Gastroesophageal Reflux in Acutely Hospitalized Patients. Dig Dis Sci 44, 140–148 (1999). https://doi.org/10.1023/A:1026618620480

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  • DOI: https://doi.org/10.1023/A:1026618620480

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