Extra-esophageal symptoms in individuals with and without erosive esophagitis: a case-control study in Albania.

INTRODUCTION: Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania. METHODS: A case-control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013-June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms. RESULTS: Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7-5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6-7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9-7.3). CONCLUSION: Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.

Role of intravenous omeprazole on non-variceal upper gastrointestinal bleeding after endoscopic treatment: a comparative study.

AIM: To evaluate and compare the clinical efficacy of intravenous omeprazole versus intravenous ranitidine therapy for the treatment of non-variceal upper gastrointestinal (UGI) bleeding after endoscopic therapy. METHODS: 108 patients (72 males and 36 females) admitted with non-variceal UGI bleeding in the Intensive Care Unit of the University Hospital of Durres, Albania, from 2004 to 2008, were included in the study. Patients with gastro-duodenal malignancy and those who were previously receiving anti-secretory drugs were excluded. All patients were treated endoscopically by injecting epinephrine (diluted 1:10.000) followed by ethanol and subsequently were randomized to receive either intravenous omeprazole (with an initial dose of 80 mg, followed by 8 mg/h infusion [n = 54]), or intravenous ranitidine (100 mg bolus, followed by 100 mg boluses every 6 hours for the next 72 hours [n = 54]). RESULTS: There-bleeding rate 72 hours after endoscopic treatment was lower in the omeprazole group than in the ranitidine group (6 vs. 14 patients, respectively; OR = 3.4; 95% CI = 1.1 -7.2; P < 0.01). Less volume of blood transfusion was needed for the omeprazole group than for the ranitidine one (1.1 +/- 1.8 units vs. 2.3 +/- 2.9 units, P = 0.03). The hospitalization period was shorter among patients treated with omeprazole than among those treated with ranitidine (5.4 +/- 2.6 days vs. 6.8 +/- 3.3 days, respectively; P = 0.04). The need for surgery and the mortality rate were not statistically different between the two groups. CONCLUSION: After endoscopic treatment of non-variceal UGI bleeding, intravenous omeprazole reduced the risk of recurrent bleeding, decreased the need for blood transfusion and shortened the period of hospitalization. Intravenous omeprazole should be used in patients with non-variceal UGI bleeding after effective endoscopic treatment.