Symptomatic gastroesophageal reflux in acutely hospitalized patients

Patients admitted acutely to hospital may be at risk of increased morbidity and mortality as a result of gastroesophageal reflux and its complications . The recognized association of gastroesophageal reflux with cardiac and re spiratory disease, the use of drugs that reduce lower esophageal sphincter pressure, and the supine position in which many patients are nursed may inc rease the risk of gastroesophageal reflux. This study aimed to determine th e prevalence and severity of refluxlike symptoms in a series of consecutive unselected patients admitted acutely through the accident and emergency de partment of a district general hospital and to study the effect of hospital ization on these symptoms. Patients were interviewed by questionnaire on tw o occasions: immediately following admission and again 7-10 days later. The frequency of symptoms of heartburn, acid regurgitation, dysphagia, nausea, and belching were recorded on a 6-point scale, in addition to whether thes e symptoms occurred at night. Medication history, the number of days spent on bed rest, nasogastric intubation, and operation history were also record ed. In all, 275 patients were interviewed, of whom 229 had a second intervi ew; 27% (62) had symptoms at least once a week (49% reported symptoms at le ast once a month) prior to admission, of whom 4% (9) had daily heartburn an d/or acid regurgitation. Following admission to hospital there was a signif icant (P < 0.001) fall in the prevalence and frequency of refluxlike sympto ms. There was a significant association of refluxlike symptoms with number of days spent in bed (P < 0.05) and with the use of nonsteroidal antiinflam matory drugs in hospital (P < 0.0001). Logistic regression analysis confirm ed the association of NSAIDs with refluxlike symptoms. Nasogastric intubati on and surgery were not associated with heartburn. In conclusion, symptoms of heartburn and acid regurgitation become less frequent following admissio n to hospital. This probably relates to a reduction in physical exertion fo llowing hospital admission but may reflect a reduction in anxiety levels or treatment of underlying disease. Patients on prolonged bed rest and those given non-steroidal anti-inflammatory drugs are at increased risk of reflux like symptoms and may require antireflux measures.