Evaluation of 24-hour pH-metry in patients with rheumatological diseases taking non-steroidal antiinfammatory drugs
D. Abdulganieva, N. Belyanskaya, I. Salikhov
Department of Hospital therapy, Kazan State Medical University, Kazan, Russian Federation
Introduction Non-steroidal antiinfammatory drugs (NSAID) are widely using medications in treatment of symptoms in patients with rheumatological diseases. The rate of NSAID-associated gastrointestinal events in Republic of Tatarstan (Russian Federation) varies from 35 to 55%. One of the factors which predispose to NSAID-induced gastropathy is gastric acid secretion.
Aims & methods The objective of this study was to evaluate the 24-hour pH-metry in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) taking NSAIDs. 45 patients were prospectively included into study — 19 patients with RA and 26 — О A, taking NSAIDs (diclofenac) more than a month. All patients were undergone upper gastrointestinal endoscopy (((Olympus)} GIF-E). 24-hours pH-metry was done by "Gastroscan-24" (Fryazino, Russia), after previous discontinuation of proton pump inhibitors — 72 hours, H2-blockers — 48 hours prior to study. The gross appearance of the upper gastrointestinal mucosa at endoscopy revealed prominent hyperemia of stomach and duodenum mucosa in 84.21% of patients with RA and 69.23% of patients with OA, erosions were seen in 19.3% with OA, the scars from the ulcer in duodenum — in 5.26% of patients with RA and 11.54% in OA group.
Results In patients with OA we observed decrease of acidity at night time comparing to day time in esophagus from 6.08 to 6.25 (mean), in stomach from 3.02 to 3.76 (mean) (p < 0.05). In patients with RA we also observed decrease of acidity at night time comparing to day time in esophagus from 5.77 to 6.29 (mean), in stomach from 3.15 to 4.24 (mean) (p < 0.05).
Conclusion In patients with RA and OA we revealed normal values of pH in esophagus, and hypoacidity in stomach, patients with RA showed higher acidity in esophagus and lower in stomach. In both group of patients we’ve seen decrease of acidity in esophagus and stomach during the night. Decrease of acidity in the stomach in patients with rheumatological disorders taking diclofenac may be due to the main disease.