Abstract
Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory care visits for ARI (visits during a 7-day period bundled into one episode), were compared between the patient groups during the 1-year period before and after the index date (date of GERD diagnosis for study patients, first ambulatory visit in the same year for their matched comparison counterpart). Multiple regression analysis using a difference-in-difference approach was performed to estimate the adjusted association between GERD treatment and the subsequent annual ARI rate. We found that the mean annual ARI episode rate among GERD patients reduced by 11.4%, from 4.39 before PPI treatment, to 3.89 following treatment (mean change = -0.5 visit, 95% confidence interval (CI) = (-0.64, -0.36)). In Poisson regression analysis, GERD treatment showed an independent association with the annual ARI rate, showing a negative estimate (with p<0.001). The study suggests that GERD treatment with PPIs may help reduce healthcare visits for ARIs, highlighting the importance of treatment-seeking by GERD patients and compliance with treatment.
Highlights
Gastroesophageal reflux disease (GERD), which often presents with symptoms of heartburn and acid regurgitation, is a common chronic disorder in many countries [1]
The graph shows a reduction in the annual acute respiratory infections (ARIs) episode rate among GERD patients
Based on reviewing the documented literature, this is the first study to examine the benefit of treating GERD with a pump inhibitor (PPI) in reducing the ARI complications of GERD
Summary
Gastroesophageal reflux disease (GERD), which often presents with symptoms of heartburn and acid regurgitation, is a common chronic disorder in many countries [1]. In Western populations, about 10%~20% of the population report having GERD symptoms at least weekly [2,3], while in East Asia, the prevalence ranges between 2.5%~7.8% [2,4,5]. Patients with GERD frequently report extra-esophageal symptoms ranging from pharyngitis, laryngitis, asthma, and hoarseness to more serious pulmonary aspiration syndromes, including bronchiectasis, lung abscesses, and recurrent pneumonias [10,11]. Among patients with erosive esophagitis, respiratory symptoms were more prevalent, with evidence of a direct association between the severity of airway obstruction and that of GERD symptoms
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