Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints

Abstract Background: The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. Objective: To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. Methods: Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. Results: There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. Conclusions: The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.

摘要 背景：既往已有研究通过血清学检测证实了胃肠道系统疾病与不宁腿综合征/Willis-Ekbom病（Restless Legs Syndrome/Willis-Ekbom disease，RLS/WED）之间的关联，但截至目前，该关联尚未得到组织病理学研究的支持。目的：本研究旨在探讨因胃肠道（gastrointestinal system, GIS）不适接受内镜检查的确诊RLS患者中，该病与上消化道内镜影像及组织病理学结果之间的关联。方法：本研究为病例对照研究，纳入100例确诊RLS且伴有消化不良症状、接受上消化道内镜检查的患者，以及106例年龄与性别相匹配的对照人群。RLS的诊断依据国际不宁腿综合征研究小组制定的四项主要诊断标准。所有研究对象均接受了上消化道内镜检查，并至少获取1份胃或胃窦活检标本。结果：病例组与对照组在内镜下所见胃溃疡、十二指肠溃疡、胃食管反流病（gastroesophageal reflux disease, GERD）表现及幽门螺杆菌（Helicobacter pylori, HP）阳性率方面均无显著差异（p>0.05）。与对照组相比，RLS/WED患者的肠上皮化生及黏膜萎缩发生率更高（分别为p=0.026和p=0.017）。此外，RLS/WED患者的铁蛋白水平均低于参考值范围。结论：对于伴有消化不良症状的RLS/WED患者，若检测到其肠上皮化生、黏膜萎缩及胃部炎症程度加重，提示需对这类患者进行密切的胃肠道系统评估。不过，针对该主题开展更大样本量的随机对照试验，并通过上消化道内镜活检对患者进行评估，仍是十分必要的。