Prevalence and sociodemographic determinants of dyspepsia diagnosed with Rome III criteria at the University of Port Harcourt Teaching Hospital

SC Egboh; AE Ihekwaba; IS Wokoma

doi:10.4103/NJGH.NJGH_14_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 12 | Issue : 2 | Page : 45-49

Prevalence and sociodemographic determinants of dyspepsia diagnosed with Rome III criteria at the University of Port Harcourt Teaching Hospital

SC Egboh¹, AE Ihekwaba², IS Wokoma²
¹ Federal Medical Centre, Yenagoa, University of Port-Harcourt Teaching Hospital, Port Harcourt, Nigeria
² University of Port-Harcourt Teaching Hospital, Port Harcourt, Nigeria

Date of Submission	15-Apr-2020
Date of Decision	16-Apr-2020
Date of Acceptance	09-Jun-2020
Date of Web Publication	10-Dec-2020

Correspondence Address:
Dr. S C Egboh
Federal Medical Centre, Yenagoa, University of Port-Harcourt Teaching Hospital, Port-Harcourt
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJGH.NJGH_14_20

Abstract

Introduction: Dyspepsia is a common symptom worldwide and has been reported to account for a considerable proportion of general practice and gastroenterology consultation. It could be subclassified as structural, functional, or uninvestigated dyspepsia. Uninvestigated dyspepsia refers to dyspeptic symptoms in persons whom no diagnostic investigations have been performed. The aim of this study is to determine the prevalence and sociodemographic characteristics of patients with Rome III features of dyspepsia.
Materials and Methods: It was a cross-sectional descriptive study where all patients who presented with any of the Rome III features of dyspepsia and had no diagnostic investigations done to ascertain the cause of the dyspepsia during the study period were recruited as test subjects. The controls were age- and sex-matched asymptomatic hospital staff.
Results: A total of 130 test subjects and 65 controls were recruited and used for the data analysis. More females were recruited among the test subjects than males with a ratio of 1.4:1, respectively. The most common age group was the fifth decade of life, and the proportion of patients with symptoms of dyspepsia thereafter reduced with increasing age. Epigastric pain (95.4%) was the most prevalent feature of dyspepsia. Early satiety accounted for 15.4%, while the least prevalent was postprandial distress. Heartburn was the most common symptom associated with Rome III features of dyspepsia.
Conclusion: Epigastric pain was found to be the most prevalent Rome III feature of dyspepsia, while heartburn is the most associated symptom.

Keywords: Dyspepsia, prevalence, Rome III

How to cite this article:
Egboh S C, Ihekwaba A E, Wokoma I S. Prevalence and sociodemographic determinants of dyspepsia diagnosed with Rome III criteria at the University of Port Harcourt Teaching Hospital. Niger J Gastroenterol Hepatol 2020;12:45-9

How to cite this URL:
Egboh S C, Ihekwaba A E, Wokoma I S. Prevalence and sociodemographic determinants of dyspepsia diagnosed with Rome III criteria at the University of Port Harcourt Teaching Hospital. Niger J Gastroenterol Hepatol [serial online] 2020 [cited 2023 Mar 21];12:45-9. Available from: https://www.njghonweb.org/text.asp?2020/12/2/45/302900

Introduction

Dyspepsia is a symptom complex in which epigastric pain or discomfort is the major presentation. This encompasses a broad range of upper gastrointestinal symptoms of varying intensity, description, and location.^[1],[2] These symptoms are the most common reason for outpatient's visit to the general practitioner and it also accounts for 20%–40% of gastroenterology appointments.^[3] There have been different consensus definitions of dyspepsia, but the definition by the Rome working team (a nonprofit organization that provides scientific research and educational information to improve diagnosis and treatment of functional gastrointestinal disorders) is globally accepted. In 1991, the working committee defined dyspepsia as pain or discomfort centered in the upper abdomen and it was designated as Rome I.^[4] Later, the Rome II working team came up with a new definition, in which it excluded patients with predominant heartburn from dyspepsia and considered them to have gastroesophageal reflux disease (GERD). The working team later proposed the Rome III criteria, in which it defined dyspepsia as the presence of one or more of these symptoms considered to originate from the gastroduodenal region, which include bothersome postprandial fullness, epigastric pain or burning, and early satiety.^[5] The postprandial fullness and early satiety were then subclassified under postprandial distress syndrome, while epigastric pain or burning was referred to as epigastric pain syndrome.^[6],[7] The postprandial distress syndrome can also be referred as meal-induced dyspeptic symptoms, while epigastric pain syndrome is meal un-related.^[7] The most recent criteria from this group are the Rome IV criteria in 2016 designed to minimize stigmatization and address the concept of gut–brain interaction as a pathogenetic mechanism for dyspepsia.^[8] The terminology functional abdominal pain syndrome was changed to centrally mediated abdominal pain syndrome, and emphasis was laid on postprandial distress syndrome and epigastric pain syndrome rather than functional dyspepsia.^[8],[9]

Aim

This study is therefore set to determine the prevalence and sociodemographic characteristics of patients with dyspepsia in the University of Port Harcourt Teaching Hospital (UPTH) using Rome III criteria.^[10],[11]

Materials and Methods

Study design

The study was carried out at the (UPTH over a period of 6 months from November 2016 to April 2017. The hospital is located in Alakahia, in Obio-Akpor local government area of Rivers State, and shares boundary with the University of Port Harcourt. It was a cross-sectional descriptive study where all patients who presented to the Medical ward, General Outpatient Department and Medical Outpatient Clinic of the UPTH, with the presence of one or more of Rome III diagnostic criteria of dyspepsia, namely bothersome postprandial fullness, epigastric pain or burning, and early satiety^[5] and whose cause of dyspepsia was yet to be determined were consecutively recruited. Patients who have any of the alarm symptoms of dyspepsia or were found to be pregnant were excluded from the study. Age- and sex-matched asymptomatic hospital staff were recruited as controls. Ethical approval was obtained from the Ethical Committee of the UPTH before the commencement of the study and informed written consent was obtained from all subjects willing to participate in the study. A structured interviewer-administered questionnaire was used to establish the Rome III features of dyspepsia and other symptoms associated with dyspepsia. Data were analyzed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, Illinois, USA IBM version 22).^[12] Continuous variables were presented as mean ± standard deviation (SD) and compared using the Student t-test. Categorical variables were represented as proportions and they were compared using Chi-square test. P< 0.05 was considered statistically significant.

Results

Sociodemographic characteristics of the study population

The mean age (± SD) of the cases was 41.0 (±12.8) years, with a range of 19–72 years [Table 1]. There was no significant difference between the ages of the test and control subjects (P = 0.99). The most common age group among the test subjects is the fifth decade of life. Among the case subjects, there were 75 (57.7%) females and 55 (42.3%) males, giving a ratio of 1.4:1. There was no significant gender difference in the distribution of the study population (P = 0.92).

Table 1: Age and sex distribution of the study population

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Distribution of the social status of the study population

As shown in [Table 2], the working class and middle class were the predominant groups among the test subjects, while the professionals were more represented among the controls.

Table 2: Distribution of social status of the subjects

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Distribution of the study population based on their body mass index

As illustrated in [Table 3], most of the cases belong to the overweight (40.0%) and normal weight (33.1%) category. Majority of the controls had normal weight (32.3%), while obesity Class III represented the least pattern of body mass index (BMI) category in both the groups.

Table 3: Distribution of the study population based on their body mass index category

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Prevalence of Rome III features of dyspepsia

One hundred and 24 (95.4%) of the cases had epigastric pain, while 20 (15.4%) and 17 (13.1%) presented with early satiety and postprandial fullness, respectively. Therefore, epigastric pain syndrome which accounted for 95.4% of the symptoms of dyspepsia was found to be most common than postprandial distress syndrome (early satiety and postprandial fullness) reported by 37 (28.5%) of the recruited patients.

Frequency of other symptoms of dyspepsia associated with Rome III criteria

As shown in [Figure 1], Heartburn was found to be the most common symptom associated with Rome III features of dyspepsia reported by 68 (52.3%) of the cases and the least was water brash reported by 5 (3.8%) of the subjects as shown in [Table 4]. Some of the cases had more than one associated symptom of dyspepsia.

Figure 1: Prevalence of Rome III features of dyspepsia

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Table 4: Distribution of other associated symptoms of dyspepsia

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Discussion

Dyspepsia is a common disorder which is not life-threatening but has a long-lasting symptomatology that may interfere with daily activities and quality of life of affected patients.^[4] The study participants consisted of more females than males, this is consistent with some studies^{[13],[14],[15]} where female patients were also reported to have a higher prevalence of dyspepsia. It could be because females are more likely to seek health attention generally than males. Park et al.^[16] reported sex-related differences in gastric motility and visceral hypersensitivity and was significantly correlated with gastroduodenal symptoms.

Majority of the dyspeptic patients were in the fourth and fifth decades of life, and the proportion of patients who presented with these symptoms reduced with increasing age thereafter. Olokoba et al.^[14] in a Nigerian study reported that most of their recruited dyspeptic patients were in the third and fourth decades of life. The findings in this study are consistent with that by Jones et al.^[17] who also reported a reduction in the frequency of symptoms of dyspepsia with increasing age. However, it differs from that by Barzkar et al.^[4] who reported that elderly patients aged 70 years and above are more likely to present with the symptoms of dyspepsia. This difference could be because the study done by Barzkar et al. was a household survey where elderly patients are more likely to be recruited than the young and middle aged who may have gone to work.

Majority of the cases belong to the working and middle class and there was a significant difference between the social classes of the cases and controls. This suggests that dyspepsia is most common in people of low socioeconomic status or it could be because the controls were recruited from the staff of a tertiary institution who belong to a higher socioeconomic class. Moreover, people who are of a lower socioeconomic class are more likely to visit public hospitals which are usually more affordable than private hospitals. The relationship between dyspepsia and socioeconomic factors seems to be less well established and widely varies with the prevalence of Helicobacter pylori in a population. Furthermore, there is inhomogeneity in social classification globally, and this may affect its association with dyspepsia. In a Rwandan study, socioeconomic factors were found to be associated with the severity of dyspepsia in a univariate model, although that association was not significant when a multivariate analysis was done.^[15]

In this study, there was no statistically significant difference in the BMI of dyspeptic patients compared to asymptomatic participants. Population-based studies among undergraduate students in Nigeria did not find any significant correlation between BMI and reflux symptoms which have similarities with dyspeptic symptoms.^[18],[19]

In this study, epigastric pain was the most common symptom of dyspepsia using the Rome III criteria. Pain is one of the most common symptoms that brings a patient to the hospital, and those who have early satiety and postprandial fullness may not appreciate the importance of visiting a medical practitioner. Early satiety and postprandial fullness accounted for 15.4% and 13.0% of the Rome III features of dyspepsia, respectively. Almeida et al.^[20] in Brazil recruited 376 dyspeptic patients and reported that early satiety and postprandial fullness accounted for 3.5% and 6.7% of dyspeptic symptoms, respectively. However, the findings in this study are different from that by Barzkar et al.^[4] in Iran, who reported bothersome postprandial fullness as the most common Rome III feature of uninvestigated dyspepsia. The difference could be because of the larger sample size used by Barzkar et al. Moreover, their study is a household survey where patients who do not have pain are more likely to be recruited.^[4]

According to the Rome III criteria, patients who have pain as their predominant symptom are categorized into epigastric pain syndrome, while those whose major symptoms are early satiety and postprandial fullness are grouped into the postprandial distress syndrome subclass. We found that majority of the patients in this study had epigastric pain syndrome (95.4%) compared to postprandial distress syndrome (28.5%) and there was an overlap of symptoms among these patients. A study conducted in Nairobi reported that epigastric pain syndrome (57%) accounted for more Rome III symptoms when compared to postprandial distress syndrome (9%) and about 29% of the patients in that study had an overlap of symptoms.^[21] However, a Chinese study, among undergraduate students with dyspepsia, actually found symptoms of postprandial distress syndrome (95.37%) to be more prevalent than that of epigastric pain syndrome (4.63%).^[22]

Heartburn which is a burning sensation at the epigastrium that radiates retrosternally^[23] was the most common symptom associated with dyspepsia seen in 52.3% of the recruited patients. These findings can be explained by the similarity in the terms used to describe epigastric pain or burning and heartburn. This report is consistent with that by Almeida et al.'s study^[20] who also reported heartburn to be the most common symptom of dyspepsia associated with Rome III criteria present in 52.5% of their subjects. Moreover, symptoms of GERD have long been documented to coexist with that of dyspepsia and this is one of the challenges in defining dyspepsia.^[24] This is even more glaring among patients who have epigastric pain syndrome. Xiao et al.^[25] reported that 37% of patients complaining of dyspeptic symptoms who fit into the subgroup of epigastric pain syndrome also have gastroesophageal acid reflux proven by pH monitoring despite normal endoscopy findings.

This study is clinically relevant as it was able to determine the pattern of Rome III symptoms of dyspepsia in Port-Harcourt and ascertained the sociodemographic determinants of these presentations. It will also stimulate more population based studies in the future.

Our study has some limitation which includes the use of controls (hospital staff), who are not homogeneous with the test subjects. The sample size used may reduce the power of the study.

Conclusion

Epigastric pain syndrome is a more frequent Rome III feature of dyspepsia than postprandial distress syndrome, and heartburn which is predominantly a symptom of GERD is the most associated with Rome III criteria. Therefore, it may be challenging for physicians to distinguish GERD from dyspepsia based on ROME III criteria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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