Abstract
PurposeThe prevalence of gastroesophagel reflux disease (GERD) has steadily increased. However, the association between GERD itself and the risk of pneumonia remains unclear. This study aimed to investigate the association between GERD and long-term risk of pneumonia and to identify the major risk factors for pneumonia in GERD patients.MethodsUsing the Taiwan National Health Insurance Research Database, we identified patients who were newly diagnosed with GERD and treated with proton pump inhibitors (PPIs) from January 1, 2004 through December 31, 2010. Two groups comprising 15,715 GERD cases and 15,715 non-GERD matched controls were generated using propensity score matching, thereby making the differences in basic demographics, concomitant medication use, and comorbidities between the two groups inconsiderable.ResultsCumulative incidence of pneumonia was significantly higher in the patients with GERD than that in the non-GERD matched controls, with an adjusted HR of 1.48 (95% confidence interval [CI] = 1.31–1.67; P < 0.001) within 6-year follow-ups. Multivariate stratified analyses revealed similar results in many subgroups, with a highest risk in individuals younger than 40 years of age (HR = 2.17, 95% CI = 1.48–3.19). Crucially, patients with GERD using PPIs longer than 4 months were at a significantly increased risk of pneumonia than those who did not use PPIs or took PPIs less than 4 months.ConclusionsGERD was significantly associated with long-term risk of pneumonia, especially in GERD with PPI use longer than 4 months or in the young population. Further prospective longitudinal studies should be conducted for validation and implementing clinical practice guidelines.
Highlights
Gastroesophageal reflux disease (GERD) is a common disorder with prevalence ranging from 10% to 28% in Western countries and from 2.5% to 7.8% in Asia [1]
Cumulative incidence of pneumonia was significantly higher in the patients with GERD than that in the non-GERD matched controls, with an adjusted hazard ratio (HR) of 1.48 (95% confidence interval [CI] = 1.31–1.67; P < 0.001) within 6-year follow-ups
GERD was significantly associated with long-term risk of pneumonia, especially in GERD with pump inhibitors (PPIs) use longer than 4 months or in the young population
Summary
Gastroesophageal reflux disease (GERD) is a common disorder with prevalence ranging from 10% to 28% in Western countries and from 2.5% to 7.8% in Asia [1]. Respiratory disorders, including recurrent pneumonia, asthma, chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis, result in bothersome clinical symptoms and complications [2]. Epithelium damage and inflammation caused by reflux materials are proposed as pivotal causes of GERD-related pulmonary diseases [3]. Proton pump inhibitors (PPIs) are indicated for a variety of gastric acid-related conditions, including GERD, peptic ulcer disease, Helicobacter Pylori infections, and other hypersecretory conditions. The use of potent PPIs has been proposed to cause an increase in gastric pH and is in connection with community-acquired respiratory tract infection, definitely pneumonia [4,5,6,7]
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