情感性精神疾病、精神作用藥物使用與罹患胃食道逆流之關聯性分析

The Association of Mood Disorders, Psychoactive Drugs and Gastroesophageal Refl ux Disease (GERD): A National Populationbased Study

目的：本研究為探討情感性疾病、精神疾患治療藥物與胃食道逆流(GERD) 的關係。 方法：資料來源為2003-2006 年全民健保資料庫，選取2004 年初次診斷情感性疾病，且2003 年未有GERD 記錄的病人，對照組為2003-06 年皆未罹患精神疾病，追蹤後續2 年是否出 現GERD 診斷。情感性疾病分為憂鬱症以及雙極性疾患；精神治療藥物分為抗憂鬱劑及抗 精神病藥，並計算罹患GERD 前平均每天服用之精神疾患藥物的平均次數(ADF)。研究使用 logistic regression，在控制性別、年齡、Charlson Comorbidity Index 的干擾後，瞭解疾病 以及ADF 對GERD 的影響。結果：病例組GERD 發生率為4.14%，對照組為1.60%。雙極 性疾患、憂鬱症病人罹患GERD 風險是無精神疾病病人的1.94 以及2.48 倍(p < 0.001)；抗 精神病藥物、抗憂鬱劑之ADF 為1 次以上是小於1 次的1.77 以及2.55 倍(p < 0.001)。結論： 情感性疾病以及精神疾患治療藥物都會增加後續GERD 的發展性。不論病人是否罹患精神 疾病，都應特別注意服用抗憂鬱藥物之頻率，當ADF 為1 次以上時，需留意病人後續是否 有發生食道上的不適感。

Objective: This study was to examine the association of mood disorders and psychoactive drugs with GERD. Method: In this study, we retrospectively analyzed 2003-2006 Taiwan National Health Insurance Research Database (NHIRD). The case cohort included patients who were fi rst diagnosed with a mood disorder in 2004 but did not have a previous diagnosis of GERD, and the control cohort included patients who did not have mental disorders. Both cohorts were followed over a period of two years. Mood disorders were classifi ed as major depressive disorder or bipolar disorder, and psychoactive drugs were classifi ed as antidepressant drugs or antipsychotic drugs. We also calculated the average daily frequency (ADF) of psychoactive drugs use before the occurrence of GERD in patients. Logistic regression was used in this study to investigate the association of mood disorders and ADF of psychoactive drugs use with GERD. Results: The incidence of GERD was 4.14% in the case cohort and 1.60% in the control cohort. The risk of GERD in patients with bipolar disorder and major depressive disorder compared with control were 1.94 and 2.48 (p < 0.001). The risk of GERD in the patients who took antipsychotic drugs or antidepressant drugs with an ADF of one or more times compared with an ADF of less than one were 1.77 and 2.55 (p < 0.001). Conclusion: Mood disorders and use of psychoactive drugs were highly associated with GERD. In addition, a patient’s ADF of antidepressant use should be carefully observed, regardless of whether the patient has a mental disorder. When ADF of a patient is one or more, then the patient should be followed up for any esophageal irritability.