Changes in gastic and esophageal acidity in patients with rheumatoid arthritis taking non-steroidal anti-inflammatory drugs
L. Myasoutova, D. Abdulganieva, N. Belyanskaya
Kazan State Medical University, Kazan, Russian Federation
Background: Non-steroidal anti-inflammatory drugs (NSAID) are widely using medications in treatment of symptoms in patients with rheumatoid arthritis (RA). The rate of NSAID-associated gastrointestinal events varies from 35 to 55%. One of the factors which predispose to NSAID-induced gastropathy is gastric acid secretion.
Objectives: The objective of this study was to evaluate the 24-hour pH-metry in patients with RA taking NSAIDs.
Methods: 39 patients with RA were prospectively included into study, mean age 41,7±13,1, disease duration 8,1±6,7 and 14 healthy controls. All patients were undergone upper gastrointestinal endoscopy ("Olympus" GIF-E). 24-hours pH-metry was done by "Gastroscan-24" (Fryazino, Russia). The gross appearance of the upper gastrointestinal mucosa at endoscopy revealed prominent hyperemia of stomach and duodenum mucosa in 84,6% of patients with RA, ulcerations and scars in duodenum – in 15,6% of patients
Results: Secretion of gastric acid varied in different groups. In RA patients mean 24-hours acid secretion was 3,20±1,28, during day time – 2,91±1,25, at night – 3,53±1,77. In healthy controls mean parameters were 2,68±0,87, 2,79±0,83 and 2,41±1,02 (p<0,05) respectively. Bile acid reflux at night was observed in 23(67,65%) RA and in 5(35,71%) healthy controls.
Esophageal pH was evaluated by DeMeester parameters. In RA patients mean time with pH less than 4 was 6,93±10,49% (normal – 4,5%), time with pH less than 4 in "vertical body position" – 8,52±11,74% (normal – 8,4%), pH less than 4 in "horizontal body position" – 5,82±10,99% (normal – 3,5%), number of reflux more than 5 minutes – 3,91±6,05 (normal – 3,5), the longest reflux – 17,79±24,99 (normal – 20). In healthy control group DeMeester parameters were within normal range.
Conclusion: In patients with RA we revealed decrease of gastric acidity at night time (p<0,05), what can be explained by bile acid refluxes and reflect changes of gastroduodenal motility. In healthy control group we observed increase of gastric acidity at night time (p<0,05). Evaluation of esophageal acidity showed that RA patients had changes in DeMeester parameters.
Combined impairment of gastroesophageal and gastroduodenal motility was seen more than 1/3 patients with RA, what may be explained as by rheumatoid arthritis itself and NSAID-induced gastropathy.
Disclosure of Interest: None declared
Citation: Ann Rheum Dis 2010;69(Suppl3):677