Prevalence of functional disorders of the upper gastrointestinal tract and related consultation behaviour in an urban community from Eastern Turkey

Öz

Background/aims: Functional disorders of the upper gastrointestinal tract are common in the general population, but there is limited data on the epidemiology of the functional gastrointestinal disorders (FGID) in Turkey. The aim of the present study was to assess the prevalence of upper FGID symptoms and related consultation behavior in an urban population in the eastern part of Turkey. Materials and methods: An age- and sex-stratified random sample of community subjects (n = 933), aged 18 years and over, was drawn from the records of health care centers in the eastern Turkish city of Elazig. A detailed questionnaire assessing their upper GI symptoms and related consultation behavior was completed by the subjects (n=810). Symptoms of the upper FGID were classified according to Rome II criteria. Statistical analyses were performed using chi-square and Student's t test. Logistic regression analysis was performed to explore the association between the presence of upper FGIDs, consultation behavior and demographics. Results: 810 subjects with suitable responses for analysis were included in the survey. 43.6% of all participants had at least one upper FGID, while 9% reported more than one. Symptoms were localized as esophageal (34.6%), gastroduodenal (14.6%) and biliary (1.9%). Of the total subjects with FGID, 24.6% had consulted a doctor due to these symptoms within the previous year. Logistic regression analysis revealed that independent predictors for having an upper FGID are increasing body mass index (BMI) and lower educational level, and for consultation is advanced age. Conclusions: Upper FGIDs are a problem in an urban population in Turkey, with a prevalence of almost half of the population. Frequency of GI symptoms is associated with lower education. Obesity is a risk factor especially for functional heartburn. Advanced age was determined to be the most predictive factor for low level of health care consultation for GI symptoms.

Anahtar Kelimeler

• Epidemiology, consultation behavior, functional gastrointestinal disorders, upper gastrointestinal tract, Turkey

Elazığ şehir toplumunda fonksiyonel üst gastrointestinal bozuklukların prevalansı ve sağlık yardımı arama

Öz

Giriş ve amaç: Batı ülkelerinde genel popülasyonda üst gastrointestinal (Gİ) semptomlar yaygındır. Ülkemizde üst Gİ sistemin fonksiyonel bozuklukları ile ilgili bilgi sınırlıdır. Bu çalışma bir Doğu Anadolu şehir toplumunda özofageal, gastroduodenal ve biliyer fonksiyon bozukluklarının prevalansını ve sağlık yardımı arama davranışını incelemek amacıyla yapılmıştır. Gereç ve yöntem: Elazığ'da bulunan 18 sağlık ocağından randomize seçilen dördünde kayıtlı 18 ve üstü yaştaki sağlıklı bireyler arasından 933 kişi randomize seçildi. Sağlık ocaklarında görevli hemşireler tarafından belirlenen kişilere ulaşılarak Roma II kriterlerine göre düzenlenmiş bir anket formu dağıtıldı. Boy, ağırlık, demografik bilgiler, alarm semptomlar ve önceki tanıları kaydedildi. İstatistik analiz ki-kare, regresyon analizi ve t testi ile yapıldı. Bulgular: 933 anketten 810'u çalışmaya alındı (%87). Bireylerin %47.5'i kadın, %52.5'i erkek, yaş ortalamaları sırasıyla 36.5 ve 35.3 yıl idi. Eğitim seviyesi kadınlarda erkeklere göre (p=0.001) daha düşüktü. Globus %1.9, ruminasyon %2.2, göğüs ağrısı %4.8, fonksiyonel yanma %25.4, disfaji %3, fonksiyonel dispepsi %4.2, aerofaji %9.6, kusma %1.5, safra kesesi disfonksiyonu %1.6 ve Oddi sfinkter disfonksiyonu %0.2 oranında bulundu. Biliyer kanal semptomları kadınlarda erkeklere göre anlamlı olarak daha yüksekti. Popülasyonun %43.6'sında en az bir, %9'unda birden fazla Gİ bozukluk vardı. Özofageal semptomlar ileri yaş ve yüksek vücut kitle indeksi ile ilişkiliydi. Gİ semptomlar düşük eğitim grubunda anlamlı olarak daha yüksek oranda bildirildi. Semptomlar nedeniyle doktora başvurma oranı %24.6 olup, kadınlarda erkeklere göre ve ileri yaşlarda genç yaşlara göre belirgin olarak daha yüksekti. Sonuç: Üst Gİ kanalın fonksiyonel bozuklukları toplumumuzun yarısına yakınını etkileyen yaygın bir problemdir. Gİ semptom sıklığı düşük eğitim seviyesi ile ilişkilidir. Obezite özellikle fonksiyonel yanma için bir risk faktörüdür. Gİ semptomlar nedeniyle sağlık yardımı arama oranı düşüktür ve ileri yaş bunda en önemli faktördür.

Anahtar Kelimeler

• Epidemiyoloji, doktora başvurma, fonksiyonel gastrointestinal bozukluklar, üst gastrointestinal semptomlar, Türkiye

Kaynakça

1. Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: A systematic review. Scand J Gastroenterol. Suppl 1999; 231: 3-8.
2. Stanghellini V. Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors: results from the domestic/International Gastroenterology Surveillance Study (DI- GEST). Scand J Gastroenterol Suppl 1999; 231: 20-8.
3. Camilleri M, Dubois D, Coulie B, et al. Prevalence and socioecono- mic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study. Clin Gastroenterol Hepatol 2005; 3: 543-52.
4. Shaib Y, El-Serag HB. The prevalence and risk factors of functional dyspepsia in a multiethnic population in the United States. Am J Gastroenterol 2004; 99: 2210-6.
5. Bytzer P, Hansen JM, Schaffalitzky de Muckadell OB. Empirical H2-blocker therapy or prompt endoscopy in management of dyspep- sia. Lancet 1994; 343: 811-6.
6. Heikkinen M, Pikkarainen P, Takala J, et al. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol 1995; 30: 519-23.
7. Kwan AC, Bao TN, Chakkaphak S, et al. Validation of Rome II cri- teria for functional gastrointestinal disorders by factor analysis of symptoms in Asian patient sample. J Gastroenterol Hepatol 2003; 18: 796-802.
8. Corazziari E. Definition and epidemiology of functional gastrointes- tinal disorders. Best Pract Res Clin Gastroenterol 2004; 18: 613- 31.

9. Drossman DA, Li Z, Andruzzi E, et al. U. S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemog- raphy, and health impact. Dig Dis Sci 1993; 38: 1569-80.
10. Harvey RF, Salih SY, Read AE. Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1983; 1: 632-4.
11. Read L, Pass TM, Komaroff AL. Diagnosis and treatment of dyspep- sia. A cost-effectiveness analysis. Med Decis Making 1982; 2: 415- 38.
12. de la Loge C, Trudeau E, Marquis P, et al. Cross-cultural develop- ment and validation of a patient self-administered questionnaire to assess quality of life in upper gastrointestinal disorders: the PAGI- QOL. Qual Life Res 2004; 13: 1751-62.
13. Drossman DA, Corazziari E, Talley NJ, et al. Appendix B. The Ro- me II Modular Questionnaire. In: Drossman DA, Corazziari, J Tal- ley, WG Thompson, WE Whitehead, eds. The Functional Gastroin- testinal Disorders. McLean Virginia: Degnon 2000; 670–88.
14. Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care se- eking in the functional GI disorders: a population-based study. Am J Gastroenterol 2002; 97: 2290-9.
15. Thompson WG, Irvine EJ, Pare P, et al. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci 2002; 47: 225-35.
16. Westbrook JI, McIntosh JH, Talley NJ. The impact of dyspepsia de- finition on prevalence estimates: considerations for future researc- hers. Scand J Gastroenterol 2000; 35: 227-33.
17. Gaburri M, Bassotti G, Bacci G, et al. Functional gut disorders and health care seeking behavior in an Italian non-patient population. Recenti Prog Med 1989; 80: 241-4.
18. Welch GW, Pomare EW. Functional gastrointestinal symptoms in a Wellington community sample. N Z Med J 1990; 103: 418-20.
19. Clouse RE, Richter JE, Heading RC, et al. Functional esophageal disorders. Gut 1999; 45: II31–6.
20. Jones RH, Lydeard SE, Hobbs fonksiyonel dispepsi et al. Dyspepsia in England and Scotland. Gut 1990; 31: 401–5.
21. Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ 1989; 298: 30-2.
22. Cheng C. Seeking medical consultation: perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosom Med 2000; 62: 844-52.
23. Heaton KW, O'Donnell LJ, Braddon FE, et al. Symptoms of irritab- le bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 1992; 102: 1962-7.
24. Wade PR, Cowen T. Neurodegeneration: a key factor in the ageing gut. Neurogastroenterol Motil 2004; 16: 19-23.
25. Hafter E. Functional digestive troubles in old age. Aktuelle Geron- tol 1977; 7: 147-9.
26. Talley NJ, Zinsmeister AR, Melton RJ. 3rd. Irritable bowel syndrome in a community: symptom subgroups, and health care utilization. Am J Epidemiol 1995; 142: 76-83.
27. Bor S, Mandiracioglu A, Kitapcioglu G, et al. Gastroesophageal reflux disease in a low-income region in Turkey. Am J Gastroente- rol 2005; 100: 759-65.
28. Talley NJ, Boyce P, Jones M. Identification of distinct upper and lo- wer gastrointestinal symptom groupings in an urban population. Gut 1998; 42: 690-5.
29. Kennedy TM, Jones RH, Hungin AP, et al. Irritable bowel syndro- me, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population. Gut 1998; 43: 770-4.
30. Bernersen B, Johnsen R, Straume B. Non-ulcer dyspepsia and pep- tic ulcer: the distribution in a population and their relation to risk factors. Gut 1996; 38: 822-5.
31. Penston JG, Pounder RE. A survey of dyspepsia in Great Britain. Aliment Pharmacol Ther 1996; 10: 83-9.
32. Kay L, Jorgensen T. Epidemiology of upper dyspepsia in a random population. Prevalence, incidence, natural history, and risk factors. Scand J Gastroenterol 1994; 29: 2-6.
33. Talley NJ, Zinsmeister AR, Schleck CD, et al. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology 1992; 102: 1259-68.
34. Talley NJ, Stanghellini V, Heading RC, et al. Functional gastrodu- odenal disorders. Gut 1999; 45: II37-42.
35. Kahrilas PJ. Review article: gastro-esophageal reflux disease as a functional gastrointestinal disorder. Aliment Pharmacol Ther 2004; 20: 50-5.
36. Celebi S, Acik Y, Deveci SE, et al. Epidemiological features of irri- table bowel syndrome in a Turkish urban society. J Gastroenterol Hepatol 2004; 19: 738-43.
37. Stanghellini V. Relationship between upper gastrointestinal symp- toms and lifestyle, psychosocial factors and comorbidity in the ge- neral population: results from the Domestic/International Gastro- enterology Surveillance Study (DIGEST). Scand J Gastroenterol Suppl 1999; 231: 29-37.