Risk factors of oesophagitis in arthritic patients

Background The risk factors that precipitate the occurrence of oesophageal mucosal injury in patients on continuous nonsteroidal anti-inflammatory dru g (NSAID) therapy are unknown. Methods Outpatients who regularly consumed NSAIDs for osteoarthritis were r ecruited from a rheumatology clinic into a prospective case-control study. All patients answered a structured interview and underwent upper gastrointe stinal endoscopy. Results Of 450 eligible patients, 195 (43%) consented to be interviewed and undergo upper gastrointestinal endoscopy. Oesophagitis was diagnosed in 41 of these 195 patients (21%). The occurrence of gastric or duodenal ulcer i n individual patients did not predict the concomitant damage of the oesopha geal mucosa. Young age (odds ratio: 1.79 per decade of life; 95% confidence interval: 1.11-2.86) and hiatus hernia (odds ratio: 3.72; 95% confidence i nterval: 1.63-8.49) both increased the risk of developing oesophagitis. Whe n questioned, all oesophagitis patients revealed at least one gastrointesti nal symptom, heartburn being named most frequently (odds ratio: 4.78; 95% c onfidence interval: 2.04-11.17). The type of anti-inflammatory medication, the use of alcohol and the use of nicotine were not associated with any sig nificant risk for erosive oesophagitis. Conclusions Patients on chronic NSAID therapy for rheumatological disease s uffer frequently from erosive oesophagitis. While the risk may be higher in patients with a pre-existing tendency for gastro-oesophageal reflux, any c oncomitant history of NSAID-induced peptic ulcer disease does not add to th e risk. Erosive oesophagitis should be considered especially in patients on NSAIDs who complain of heartburn. (C) 2001 Lippincott Williams & Wilkins.