Effect of Dyspepsia on Survival

Alexander C Ford MD, MRCP; David Forman BA, PhD, FFPH; Alastair G Bailey; Anthony T R Axon MD, FRCP; Paul Moayyedi BSc, PhD, MPH, FRCP, FRCPC

Disclosures

Am J Gastroenterol. 2012;107(6):912-921. 

In This Article

Abstract and Introduction

Abstract

Objectives: Most chronic and recurrent gastrointestinal (GI) symptoms in the community are caused by functional GI disorders, such as functional dyspepsia and irritable bowel syndrome (IBS). It is not known, however, whether these conditions affect mortality. We present the results of a large community-based prospective study that examines this issue.
Methods: This was a 10-year follow-up, conducted in 2004, of individuals recruited into a community-based screening program for Helicobacter pylori. Data on mortality and cause of death at 10 years were obtained from the Office for National Statistics. Baseline demographic data, lifestyle factors, GI symptoms, and quality of life were recorded at study entry. The effect of all these factors on 10-year mortality was examined using univariate analysis and multivariate Cox regression analysis. All results were expressed as hazard ratios (HRs) with 99% confidence intervals (CIs).
Results: Symptom data were available for 8,323 (99.0%) of 8,407 individuals originally enrolled, comprising over 84,000 years of follow-up: 3,169 (38.1%) subjects had dyspepsia, and 264 (3.2%) IBS. There were 137 (1.65%) individuals who had died at 10 years. After multivariate analysis, there was no significant difference in likelihood of death at 10 years in those with dyspepsia (HR: 0.94; 99% CI: 0.58–1.54) or IBS (HR: 1.35; 99% CI: 0.36–5.10), compared with those not meeting the criteria for either condition.
Conclusions: Dyspepsia was not associated with an increased mortality in the community. Data for any effect of IBS on survival were less clear. Further studies are required to assess the impact of functional GI disorders on life expectancy.

Introduction

Upper and lower gastrointestinal (GI) symptoms, such as dyspepsia, abdominal pain, and altered bowel habit are common in the general population. Most sufferers will have no structural explanation for their symptoms,[1,2] and are labeled as having one of the functional GI disorders, such as functional dyspepsia or irritable bowel syndrome (IBS). These conditions are common. In population-based questionnaire surveys, up to 40% of individuals report symptoms compatible with functional dyspepsia,[3,4] and 20% IBS,[5] depending on the criteria used to define the presence of either condition. A variable number of those who experience these symptoms will consult a primary care physician for them,[3,6,7,8,9,10] but only a minority are referred on for a specialist opinion. Functional GI disorders have consistently been shown to impact adversely on quality of life,[11,12,13] and they lead to considerable morbidity in the community as a result.

Although advances have been made in the understanding of the pathophysiology underlying these disorders, no structural lesion has been identified toward which treatment can be directed. As a result, most patients receive therapy targeted toward the predominant, or most troublesome, symptom that they experience, together with reassurance that there is no serious underlying cause for their symptoms. Indeed, it has always been assumed that functional GI disorders do not adversely affect the life expectancy of sufferers.

Despite this assumption, there is a dearth of information concerning the impact of GI symptoms on survival. In a recent population-based study conducted in the United States,[14] there appeared to be no association between symptoms compatible with either functional dyspepsia or IBS and survival, in a sample of almost 4,000 individuals with over 30,000 years of follow-up. However, more studies of similar design, in different populations, are required to confirm or refute the findings of these investigators. We have an excellent opportunity to address this deficit in current knowledge, in a large sample of individuals randomly selected from the general population and invited to participate in a community screening and treatment program for Helicobacter pylori (H. pylori). Furthermore, we have been able to evaluate whether there is an increase in mortality in patients with a combination of functional GI disorders, an issue not examined previously.

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