Print

Indigestion

Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland

Type
Disease or Syndrome
ID
PH867
Version ID
1813
Data Sources
Valid event data range
01/01/2005 - 30/11/2018
Sex
Female, Male
Agreement Date
2022-02-02
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Studies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.

Methods:

This cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018. It included people aged 18–99 years with depression first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine (5081), a different SSRI (15,032), amitriptyline (3905), or venlafaxine (1580). Follow-up was from starting to stopping the second antidepressant, with a 6-month wash-out window, censoring at the end of CPRD follow-up or 30 November 2018. Age-sex standardised rates of all-cause mortality and death due to circulatory system disease, cancer, or respiratory system disease were calculated. Survival analyses were performed, accounting for baseline characteristics using inverse probability of treatment weighting.

Results:

The cohort contained 25,598 people (median age 41 years). The mirtazapine group had the highest standardised mortality rate, with an additional 7.8 (95% confidence interval (CI) 5.9–9.7) deaths/1000 person-years compared to the SSRI group. Within 2 years of follow-up, the risk of all-cause mortality was statistically significantly higher in the mirtazapine group than in the SSRI group (weighted hazard ratio (HR) 1.62, 95% CI 1.28–2.06). No significant difference was found between the mirtazapine group and the amitriptyline (HR 1.18, 95% CI 0.85–1.63) or venlafaxine (HR 1.11, 95% CI 0.60–2.05) groups. After 2 years, the risk was significantly higher in the mirtazapine group compared to the SSRI (HR 1.51, 95% CI 1.04–2.19), amitriptyline (HR 2.59, 95% CI 1.38–4.86), and venlafaxine (HR 2.35, 95% CI 1.02–5.44) groups. The risks of death due to cancer (HR 1.74, 95% CI 1.06–2.85) and respiratory system disease (HR 1.72, 95% CI 1.07–2.77) were significantly higher in the mirtazapine than in the SSRI group.

Conclusions:

Mortality was higher in people prescribed mirtazapine than people prescribed a second SSRI, possibly reflecting residual differences in other risk factors between the groups. Identifying these potential health risks when prescribing mirtazapine may help reduce the risk of mortality.

Publications

  • Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland, The risk of all-cause and cause-specific mortality in people prescribed mirtazapine an active comparator cohort study using electronic health records. BMC Medicine, 20(43), 2022.

Clinical Code List

Rows: 118
Code Description Entity type Category Coding System (Read)
171J.00 reflux cough res176: Indigestion diagnostic Read
195..00 indigestion symptoms res176: Indigestion diagnostic Read
1952.00 regurgitates food res176: Indigestion diagnostic Read
1952.11 regurgitation res176: Indigestion diagnostic Read
1953.00 waterbrash res176: Indigestion diagnostic Read
1953.11 waterbrash symptom res176: Indigestion diagnostic Read
1954.00 indigestion res176: Indigestion diagnostic Read
1955.00 heartburn res176: Indigestion diagnostic Read
1955.11 heartburn symptom res176: Indigestion diagnostic Read
1956.00 peptic ulcer symptoms res176: Indigestion diagnostic Read
1957.00 gastric reflux res176: Indigestion diagnostic Read
1958.00 undiagnosed dyspepsia res176: Indigestion diagnostic Read
195Z.00 indigestion symptom nos res176: Indigestion diagnostic Read
198..00 nausea res176: Indigestion diagnostic Read
198..11 c/o - nausea res176: Indigestion diagnostic Read
198..12 nausea symptoms res176: Indigestion diagnostic Read
1981.00 no nausea res176: Indigestion diagnostic Read
1982.00 nausea present res176: Indigestion diagnostic Read
1983.00 morning nausea res176: Indigestion diagnostic Read
1984.00 upset stomach res176: Indigestion diagnostic Read
1984.11 upset tummy res176: Indigestion diagnostic Read
198Z.00 nausea nos res176: Indigestion diagnostic Read
199..00 vomiting res176: Indigestion diagnostic Read
199..11 c/o - vomiting res176: Indigestion diagnostic Read
199..12 emesis res176: Indigestion diagnostic Read
199..13 rumination res176: Indigestion diagnostic Read
199..14 vomiting symptoms res176: Indigestion diagnostic Read
1991.00 no vomiting res176: Indigestion diagnostic Read
1992.00 vomiting res176: Indigestion diagnostic Read
1992.11 throwing up res176: Indigestion diagnostic Read
1992.12 bilious attack res176: Indigestion diagnostic Read
1993.00 projectile vomiting res176: Indigestion diagnostic Read
1994.00 vomiting blood - fresh res176: Indigestion diagnostic Read
1994.11 blood in vomit - symptom res176: Indigestion diagnostic Read
1995.00 vomiting blood - coffee ground res176: Indigestion diagnostic Read
1996.00 vomiting - bile stained res176: Indigestion diagnostic Read
1997.00 retching res176: Indigestion diagnostic Read
1999.00 frequency of vomiting res176: Indigestion diagnostic Read
199Z.00 vomiting nos res176: Indigestion diagnostic Read
19A..00 abdominal distension symptom res176: Indigestion diagnostic Read
19A2.00 abdomen feels bloated res176: Indigestion diagnostic Read
19A3.00 abdomen feels distended res176: Indigestion diagnostic Read
19A4.00 abdomen feels swollen res176: Indigestion diagnostic Read
19AZ.00 abd. distension symptom nos res176: Indigestion diagnostic Read
19B..00 flatulence/wind res176: Indigestion diagnostic Read
19B..11 belching symptom res176: Indigestion diagnostic Read
19B..12 bloating symptom res176: Indigestion diagnostic Read
19B..13 eructation symptom res176: Indigestion diagnostic Read
19B..14 flatulence symptom res176: Indigestion diagnostic Read
19B..15 wind symptom res176: Indigestion diagnostic Read
19B2.00 excessive flatulence res176: Indigestion diagnostic Read
19B3.00 excessive belching res176: Indigestion diagnostic Read
19B4.00 excessive eructation res176: Indigestion diagnostic Read
19B5.00 excessive flatus res176: Indigestion diagnostic Read
19BZ.00 wind nos res176: Indigestion diagnostic Read
19FZ.11 diarrhoea & vomiting, symptom res176: Indigestion diagnostic Read
19G..00 diarrhoea and vomiting res176: Indigestion diagnostic Read
J101100 reflux oesophagitis res176: Indigestion diagnostic Read
J101111 acid reflux res176: Indigestion diagnostic Read
J101112 gastro-oesophageal reflux with oesophagitis res176: Indigestion diagnostic Read
J101113 oesophageal reflux with oesophagitis res176: Indigestion diagnostic Read
J10y400 oesopheal reflux without mention of oesophagitis res176: Indigestion diagnostic Read
J10y411 oesophageal reflux res176: Indigestion diagnostic Read
J10y412 gastro-oesophageal reflux res176: Indigestion diagnostic Read
J10y413 acid reflux res176: Indigestion diagnostic Read
J10y500 laryngopharyngeal reflux res176: Indigestion diagnostic Read
J154111 biliary reflux res176: Indigestion diagnostic Read
J161.00 acute dilatation of stomach res176: Indigestion diagnostic Read
J162.00 persistent vomiting res176: Indigestion diagnostic Read
J162.11 emesis - persistent res176: Indigestion diagnostic Read
J162z00 persistent vomiting nos res176: Indigestion diagnostic Read
J16y200 hyperchlorhydria res176: Indigestion diagnostic Read
J16y211 hyperacidity res176: Indigestion diagnostic Read
J16y300 hourglass stomach contraction res176: Indigestion diagnostic Read
J16y400 dyspepsia res176: Indigestion diagnostic Read
J16y411 flatulent dyspepsia res176: Indigestion diagnostic Read
J16y412 indigestion nos res176: Indigestion diagnostic Read
J16y500 functional vomiting res176: Indigestion diagnostic Read
J16y600 gastric atonia res176: Indigestion diagnostic Read
J16y700 gastric spasm res176: Indigestion diagnostic Read
J16y800 gastric dysmotility res176: Indigestion diagnostic Read
J16y900 delayed gastric emptying res176: Indigestion diagnostic Read
J16yA00 non-ulcer dyspepsia res176: Indigestion diagnostic Read
J16yA11 functional dyspepsia res176: Indigestion diagnostic Read
J16yz00 other specified stomach function disorders nos res176: Indigestion diagnostic Read
J16z.00 stomach function disorder nos res176: Indigestion diagnostic Read
J16z100 drug induced gastrointestinal disturbance res176: Indigestion diagnostic Read
J680.00 haematemesis res176: Indigestion diagnostic Read
J680.11 vomiting of blood res176: Indigestion diagnostic Read
R070.00 [d]nausea and vomiting res176: Indigestion diagnostic Read
R070000 [d]nausea res176: Indigestion diagnostic Read
R070100 [d]vomiting res176: Indigestion diagnostic Read
R070111 [d] sickness res176: Indigestion diagnostic Read
R070200 [d]emesis res176: Indigestion diagnostic Read
R070300 [d]drug induced vomiting res176: Indigestion diagnostic Read
R070400 [d]projectile vomiting res176: Indigestion diagnostic Read
R070z00 [d]nausea and vomiting nos res176: Indigestion diagnostic Read
R070z12 [d]retching res176: Indigestion diagnostic Read
R071.00 [d]heartburn res176: Indigestion diagnostic Read
R071000 [d]pyrosis res176: Indigestion diagnostic Read
R071100 [d]waterbrash res176: Indigestion diagnostic Read
R071z00 [d]heartburn nos res176: Indigestion diagnostic Read
R072.00 [d]dysphagia res176: Indigestion diagnostic Read
R072000 [d]difficulty in swallowing res176: Indigestion diagnostic Read
R072z00 [d]dysphagia nos res176: Indigestion diagnostic Read
R073.00 [d]flatulence, eructation and gas pain res176: Indigestion diagnostic Read
R073000 [d]flatulence res176: Indigestion diagnostic Read
R073100 [d]eructation res176: Indigestion diagnostic Read
R073200 [d]gas pain (abdominal) res176: Indigestion diagnostic Read
R073300 [d]abdominal distension, gaseous res176: Indigestion diagnostic Read
R073400 [d]bloating res176: Indigestion diagnostic Read
R073500 [d]tympanites (abdominal) res176: Indigestion diagnostic Read
R073z00 [d]flatulence, eructation and gas pain nos res176: Indigestion diagnostic Read
R073z11 [d]wind res176: Indigestion diagnostic Read
R075.00 [d]bowel sounds abnormal res176: Indigestion diagnostic Read
R075100 [d]bowel sounds hyperactive res176: Indigestion diagnostic Read
R075z00 [d]abnormal bowel sounds nos res176: Indigestion diagnostic Read
R07A.00 [d]pain in oesophagus res176: Indigestion diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH867/version/1813/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH867/version/1813/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH867', '1813', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH867/version/1813/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH867/version/1813/export/codes/?format=json
CSV site_root/phenotypes/PH867/version/1813/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH867', '1813', api_client=client)

Version History

Version
ID
Name Owner Publish date
1813 Indigestion ieuan.scanlon 2022-04-04 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

Print - Print page.