Abstract
BackgroundOestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). Results of observational studies in women taking HRT rely on self-reporting of gastro-oesophageal symptoms and the aetiology of gastro-oesophageal reflux disease (GORD) remains unclear. This study investigated the association between HRT and GORD in menopausal women using validated general practice records.Methods51,182 menopausal women were identified using the UK General Practice Research Database between 1995–2004. Of these, 8,831 were matched with and without hormone use. Odds ratios (ORs) were calculated for GORD and proton-pump inhibitor (PPI) use in hormone and non-hormone users, adjusting for age, co-morbidities, and co-pharmacy.ResultsIn unadjusted analysis, all forms of hormone use (oestrogen-only, tibolone, combined HRT and progestogen) were statistically significantly associated with GORD. In adjusted models, this association remained statistically significant for oestrogen-only treatment (OR 1.49; 1.18–1.89). Unadjusted analysis showed a statistically significant association between PPI use and oestrogen-only and combined HRT treatment. When adjusted for covariates, oestrogen-only treatment was significant (OR 1.34; 95% CI 1.03–1.74). Findings from the adjusted model demonstrated the greater use of PPI by progestogen users (OR 1.50; 1.01–2.22).ConclusionsThis first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance.
Highlights
Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT)
In recognition of the reported lack of standardisation of gastro-oesophageal reflux disease (GORD) recording [25] in general practice; we investigated the association between protonpump inhibitor (PPI) and hormone use
A total of 42,724 (84%), women had ever been recorded as having GORD symptoms, with a total of 18.5% of all consultations coded as ‘Dyspepsia’, and 3.3% of consultations coded as ‘Gastro-oesophageal Reflux Disease’
Summary
Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). A Norwegian case–control study indicated that obesity increases the influence of oestrogen use upon GORD (OR 2.3; 95%CI 1.1–4.8), it is difficult to draw firm conclusions given the small numbers [12]. These findings contrast with in-vitro evidence suggesting that progestogen use may play a greater role than oestrogen in upper GI motility [23]. These European and US studies relied on self-reporting of symptoms and did not take into account time from onset of menopausal symptoms. In light of these results, the goal of this study was to establish the extent of the association between upper GI symptoms and the use of forms of HRT, and the relative importance of oestrogen compared with progestogen in the UK population
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