Peptic ulcer disease in an adult population : the Kalixanda study – a population-based endoscopic study
Author: Aro, Pertti
Date: 2007-01-11
Location: Hörsalen, entreplan, Alfred Nobels allé 12, Karolinska Institutet, Huddinge
Time: 09.00
Department: Institutionen för neurobiologi, vårdvetenskap och samhälle / Department of Neurobiology, Care Sciences and Society
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thesis.pdf (610.1Kb)
Abstract
Introduction: The pattern of symptoms and perception of disease among
patients seeking care does, due to health care seeking behaviour, most
probably not reflect the true health status in the general population.
Upper esophagogastroduodenoscopy (EGD) is considered to be gold standard
for upper gastrointestinal (GI) disease assessment, but is seldom used in
epidemiological studies. We aimed to explore whether the EG13 affects
symptom reporting and sampling among volunteers and to clarify the
prevalence of peptic ulcer disease (PUD) and its risk factors in a
general adult population.
Methods: A random sample of 3,000 adults aged 20-80 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal abdominal symptom questionnaire. A random sub-sample of the responders (n=1,001) was invited, in random order, to undergo an upper endoscopy with biopsies and repeated symptom reporting with the same questionnaire, as well as for blood samples for Helicobacter pylori (H. pylori) serology and other biomarkers, medical history taking, measuring and weighing the subjects.
Results: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n=1,001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, except for an excess of symptom reporters among the youngest subjects (< 35 years). The prevalence of gastroesophageal reflux symptoms (GERS), dyspepsia and the Irritable Bowel Syndrome (IBS) was 40%, 37.6% and 29.6%, respectively.
The prevalence of peptic ulcer was 4.1 % (gastric ulcers (GU) n=20; duodenal ulcers (DU) n=21). Nausea and GERS, but not epigastric pain/discomfort, were significant predictors of PUD. Six individuals with GU and two with DU were asymptomatic (in all 20%). Eight DU subjects (38%) lacked evidence of current H. pylori infection. Five (25%) of the GU and four (19%) of the DU were idiopathic (no aspirin/NSAID use, no H. pylori infection and normal Gastrin-17). Smoking, aspirin and obesity were risk factors for GU; smoking, low dose aspirin (¡Ü 160 mg) and H. pylori infection were risk factors for DU. There were more endoscopic findings in obese subjects than in normal weight subjects, but the differences were not significant except for esophagitis and GU; the prevalence of reflux esophagitis in obesity was 26.5% versus 9.3% in normal weight subjects and the corresponding figures for GU were 5.6% and 1.4% respectively. Different types of tobacco use do not seem to have uniform health risks. While smoking increases the risk for PUD, smokeless tobacco use does not, or might even contribute to a lower risk. Use of smokeless tobacco is a significant risk for higher prevalence of reflux esophagitis and for intestinal metaplasia in the antrum (a preneoplastic marker).
Conclusions: Valid epidemiology through upper endoscopy is possible. Smoking, aspirin and obesity are risk factors for GU; smoking, low dose aspirin (¡Ül60 mg) and H. pylori infection for DU. Smokeless tobacco is not a risk factor for PUD but most probably not harmless anyhow. Idiopathic ulcer may be more common than anticipated. PUD is often asymptomatic or coexists with atypical symptoms.
Methods: A random sample of 3,000 adults aged 20-80 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal abdominal symptom questionnaire. A random sub-sample of the responders (n=1,001) was invited, in random order, to undergo an upper endoscopy with biopsies and repeated symptom reporting with the same questionnaire, as well as for blood samples for Helicobacter pylori (H. pylori) serology and other biomarkers, medical history taking, measuring and weighing the subjects.
Results: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n=1,001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, except for an excess of symptom reporters among the youngest subjects (< 35 years). The prevalence of gastroesophageal reflux symptoms (GERS), dyspepsia and the Irritable Bowel Syndrome (IBS) was 40%, 37.6% and 29.6%, respectively.
The prevalence of peptic ulcer was 4.1 % (gastric ulcers (GU) n=20; duodenal ulcers (DU) n=21). Nausea and GERS, but not epigastric pain/discomfort, were significant predictors of PUD. Six individuals with GU and two with DU were asymptomatic (in all 20%). Eight DU subjects (38%) lacked evidence of current H. pylori infection. Five (25%) of the GU and four (19%) of the DU were idiopathic (no aspirin/NSAID use, no H. pylori infection and normal Gastrin-17). Smoking, aspirin and obesity were risk factors for GU; smoking, low dose aspirin (¡Ü 160 mg) and H. pylori infection were risk factors for DU. There were more endoscopic findings in obese subjects than in normal weight subjects, but the differences were not significant except for esophagitis and GU; the prevalence of reflux esophagitis in obesity was 26.5% versus 9.3% in normal weight subjects and the corresponding figures for GU were 5.6% and 1.4% respectively. Different types of tobacco use do not seem to have uniform health risks. While smoking increases the risk for PUD, smokeless tobacco use does not, or might even contribute to a lower risk. Use of smokeless tobacco is a significant risk for higher prevalence of reflux esophagitis and for intestinal metaplasia in the antrum (a preneoplastic marker).
Conclusions: Valid epidemiology through upper endoscopy is possible. Smoking, aspirin and obesity are risk factors for GU; smoking, low dose aspirin (¡Ül60 mg) and H. pylori infection for DU. Smokeless tobacco is not a risk factor for PUD but most probably not harmless anyhow. Idiopathic ulcer may be more common than anticipated. PUD is often asymptomatic or coexists with atypical symptoms.
List of papers:
I. Aro P, Ronkainen J, Storskrubb T, Bolling-Sternevald E, Carlsson R, Johansson SE, Vieth M, Stolte M, Engstrand L, Talley NJ, Agreus L. (2004). "Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study." Scand J Gastroenterol 39(12): 1280-8
Pubmed
II. Aro P, Storskrubb T, Ronkainen J, Bolling-Sternevald E, Engstrand L, Vieth M, Stolte M, Talley NJ, Agreus L. (2006). "Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study." Am J Epidemiol 163(11): 1025-34
Pubmed
III. Aro P, Ronkainen J, Talley NJ, Storskrubb T, Bolling-Sternevald E, Agreus L. (2005). "Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study." Gut 54(10): 1377-83
Pubmed
IV. Aro P, Ronkainen J, Storskrubb T, Bolinder G,Bolling-Sternevald E, Vieth M, Stolte M, Engstrand L, Alving K, Johansson S-E, Talley NJ, Agreus L (2006). "Smokeless tobacco use and gastrointestinal morbidity: an endoscopic population- based study. The Kalixanda-study." (Submitted)
I. Aro P, Ronkainen J, Storskrubb T, Bolling-Sternevald E, Carlsson R, Johansson SE, Vieth M, Stolte M, Engstrand L, Talley NJ, Agreus L. (2004). "Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study." Scand J Gastroenterol 39(12): 1280-8
Pubmed
II. Aro P, Storskrubb T, Ronkainen J, Bolling-Sternevald E, Engstrand L, Vieth M, Stolte M, Talley NJ, Agreus L. (2006). "Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study." Am J Epidemiol 163(11): 1025-34
Pubmed
III. Aro P, Ronkainen J, Talley NJ, Storskrubb T, Bolling-Sternevald E, Agreus L. (2005). "Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study." Gut 54(10): 1377-83
Pubmed
IV. Aro P, Ronkainen J, Storskrubb T, Bolinder G,Bolling-Sternevald E, Vieth M, Stolte M, Engstrand L, Alving K, Johansson S-E, Talley NJ, Agreus L (2006). "Smokeless tobacco use and gastrointestinal morbidity: an endoscopic population- based study. The Kalixanda-study." (Submitted)
Issue date: 2006-12-21
Rights:
Publication year: 2007
ISBN: 91-7140-986-6
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