Factors In Gastroesophageal Reflux Disease Research Articles

Prevalence and risk factors for gastroesophageal reflux disease in an impoverished minority population

An epidemiological link between an increased body mass index and complaints of typical heartburn symptoms has been identified. It appears that increasing waist circumference, rather than overall weight is most important. Studies to date have not included minority, impoverished communities. Our aim was to determine the impact of obesity on the prevalence of reflux disease in an impoverished community while controlling for known confounders. Cross-sectional survey delivered by in-home interviews, convenience sampling, and targeted mailing. Data queried include demographics, medical history, lifestyle habits, and symptoms of reflux disease. Height, weight, hip and waist circumference measured in participating subjects. 503 subjects living in the zip code immediately surrounding Temple University Hospital. Included only adults living in the hospital's zip code for at least 3 years. The highest quartile of waist circumference (≥42 in.) demonstrated a strong association with GERD (AOR = 2.15; 95% CI 1.18-3.90). Smoking increased the odds by 1.72 (95% CI 1.13-2.62). There was no relationship between body mass index, waist-hip ratio, or diet and reflux classification. Increasing waist circumference, but not overall body mass index or waist-hip ratio, and smoking are risk factors for prevalent GERD. No association between reflux disease and lifestyle choices such as coffee drinking and fast food dining were found. Potential for recall bias and disease misclassification. Possible methodological errors in self-measurement of waist and hip circumference.

Relationship between Psychological Factors and Quality of Life in Subtypes of Gastroesophageal Reflux Disease

Background/AimsQuality of life (QoL) is consistently decreased in gastroesophageal reflux disease (GERD), but the relationship between QoL and psychological factors in GERD has not yet been clearly defined. The present study investigated the relationship between the psychological factors of two subtypes of GERD and QoL.MethodsA cohort of 769 participants underwent upper endoscopic evaluation in the health-promotion center of St. Paul's Hospital. The severity of GERD symptoms, psychological factors, and QoL were analyzed using the Visual Analogue Scale, the Hospital Anxiety and Depression Scale, and the abbreviated version of the World Health Organization Quality of Life instrument, respectively.ResultsAmong the total of 769 participants, 153 participants were included in the exclusion criteria. Erosive reflux disease (ERD) and nonerosive reflux disease (NERD) were present in 106 (14%) and 61 (8%) of the participants, respectively, and 449 (58%) acted as controls. In each GERD group, the QoL had no correlatioion with the symptom severity. The scores for anxiety and depression were highest in the NERD group, and QoL scores were lower in both the ERD and NERD groups than in the control group. Anxiety and depression resulted in QoL scores being lower in both the ERD and NERD groups than in the nonanxiety and nondepressed groups, respectively.ConclusionsThis study provides evidence that the QoL associated with the ERD and NERD subtypes may be more related to psychological factors than to symptom severity.

Surfing as a Risk Factor for Gastroesophageal Reflux Disease

To compare the prevalence of gastroesophageal reflux disease (GERD) in surfers versus nonsurfers who participate in other sports activities based on the hypothesis that paddling in the prone position on hard surfboard surfaces leads to increased intra-abdominal pressure and GERD. A questionnaire survey using a modified Gastrointestinal Symptom Rating Scale. Data obtained from surfers and nonsurfer athletes on the island of Oahu in the state of Hawaii. One hundred eighty-five surfers and 178 nonsurfers who participate in sports activities. Surfer or nonsurfer status, type of surfboard used, frequency of surfing, and duration of surfing experience. The prevalence of reflux symptoms at least twice a week (GERD). The prevalence of GERD was significantly higher in short-board surfers than in nonsurfers with an odds ratio of 4.6 (28% versus 7%, P < 0.001) after adjustment for demographic variables using the multivariate regression model. GERD was more prevalent in short-boarders than long-boarders (28% and 12%, respectively). The prevalence of GERD increased significantly as both the frequency and duration of surfing experience increased (P < 0.001). Surfing is strongly associated with GERD. Short-board surfing appears to have a stronger association with GERD than long-board surfing.

Gastroesophageal Reflux Disease: A Population Based Study

BackgroundThe prevalence of gastroesophageal reflux disease varies in different parts of the world. There are no population based studies in Nigeria. The main objectives of this study were to determine the prevalence and risk factors for gastroesophageal reflux disease in a population of Nigerian medical students.MethodsThe Carlsson-Dent questionnaire was administered to medical students in the clinical phase of their training at the University of Nigeria, Enugu Campus. Some putative risk factors for gastroesophageal reflux disease were also included in the questionnaire.ResultsThe prevalence of gastroesophageal reflux disease was 26.34%. There was an association between the use of caffeine-containing substances (coffee and kolanuts) and the prevalence of gastroesophageal reflux disease (odds ratio = 2.2 and 2.015, respectively).ConclusionsGastroesophageal reflux disease is common among Nigerian medical students. The use of caffeine-containing substances (coffee and kolanuts) by students may have a role in the high prevalence.

Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran

To investigate the prevalence and risk factors of gastroesophageal reflux disease (GERD) symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms (heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough) as completed for each subject. The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% (237 subjects). The prevalence was higher in older individuals (36.0% vs 28.9%, P < 0.05) and in those with other gastrointestinal complaints (51.0% vs 27.8%, P < 0.001), but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week (36.2% vs 17.3%, P < 0.001). GERD had a positive correlation with smoking (42.1% vs 27.8%, P < 0.001), but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal anti-inflammatory drugs (NSAIDs) consumption was also significant (40.2% vs 25.4%, P < 0.001). The prevalence of GERD (33%) is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.

Clinical predictors of abnormal esophageal pH monitoring in preterm infants

Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry) > or = 10% (cases) and 87 unpaired preterms were selected with reflux index <10% (controls). Demographic variables, signs and symptoms, main diagnoses and some aspects of treatment were studied. Simple and multiple logistic regression analysis adjusted for birthweight and postconceptional age at the pH study were used. The factors associated with a greater chance of reflux index > or = 10% in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms > or = 147 mL/kg/day, and postnatal corticoid use. Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight <2000 g. Bronchopulmonary dysplasia and use of caffeine were not associated with reflux index > or = 10%.

Psychological Factors in Gastroesophageal Reflux Disease Measured by SCL-90-R Questionnaire

An association between psychological factors and gastroesophageal reflux disease has been recognized. Psychological distress can influence the outcomes of the disease. To determine the existence of psychological factors in our gastroesophageal reflux disease sample, as well as determine their influence on the outcome of the disease and treatment response. A cross-sectional study was performed from February 2006 to December 2007. Patients referred to gastrointestinal specialists who reported symptoms of gastroesophageal reflux were asked to fill out the SCL-90-R questionnaire. All underwent endoscopy and pH-metry studies. Fifty-five patients with gastroesophageal reflux disease were analyzed. Subjects with reflux symptoms had higher scores compared to healthy controls on sommatization, obsessiveness, interpersonal sensitivity, being phobic, being psychotic, and the global index (P < 0.05). Patients with high frequency of symptoms and long duration of disease have increased psychological distress. There was no relationship among pH-metry results, endoscopy findings, and SCL-90-R scores. Psychosocial factors can predispose to gastroesophageal reflux disease. The SCL-90-R questionnaire can be useful in investigating psychological factors in those patients with unsuccessful outcome of the symptoms despite correct management.

Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?

Obesity is a risk factor for gastroesophageal reflux disease (GERD) and for obstructive sleep apnea (OSA). Our aim was to evaluate in morbidly obese patients the prevalence of OSA and GERD and their possible relationship. Morbidly obese patients [body mass index (BMI) >40 or >35 kg/m(2) in association with comorbidities] selected for bariatric surgery were prospectively included. Every patient underwent a 24-h pH monitoring, esophageal manometry, and nocturnal polysomnographic recording. Sixty-eight patients [59 women and 9 men, age 39.1 +/- 11.1 years; BMI 46.5 +/- 6.4 kg/m(2) (mean +/- SD)] were included. Fifty-six percent of patients had an abnormal Demester score, 44% had abnormal time spent at pH <4, and 80.9% had OSA [apnea hypopnea index (AHI) >10] and 39.7% had both conditions. The lower esophageal sphincter (LES) pressure was lower in patients with GERD (11.6 +/- 3.4 vs 13.4 +/- 3.6 mm Hg, respectively; P = 0.039). There was a relationship between AHI and BMI (r = 0.337; P = 0.005). Patients with OSA were older (40.5 +/- 10.9 vs 33.5 +/- 10.4 years; P = 0.039). GERD tended to be more frequent in patients with OSA (49.1% vs 23.1%, respectively; P = 0.089). There was no significant relationship between pH-metric data and AHI in either the 24-h total recording time or the nocturnal recording time. In multivariate analysis, GERD was significantly associated with a low LES pressure (P = 0.031) and with OSA (P = 0.045) but not with gender, age, and BMI. In this population of morbidly obese patients, OSA and GERD were frequent, associated in about 40% of patients. GERD was significantly associated with LES hypotonia and OSA independently of BMI.

Risk factors for gastroesophageal reflux disease in very low birth weight infants with bronchopulmonary dysplasia

To assess risk factors for gastroesophageal reflux disease (GERD) in very low birth weight infants with bronchopulmonary dysplasia. A case-control study was carried out in 23 cases and 23 control subjects with bronchopulmonary dysplasia submitted to 24-hour esophageal pH monitoring between January 2001 and October 2005. Cases and controls were compared for gestational age, birth weight, gender, use of antenatal steroids, duration of assisted ventilation, duration of oxygen therapy, length of gastric tube use, administration of xanthines, postconceptual age, and weight at esophageal pH monitoring. Multiple logistic regression analysis was used to establish the odds ratio (OR) with a 95% confidence interval (95%CI). None of the groups (with and without GERD) showed statistically significant differences in terms of demographic variables and postnatal outcome, use of antenatal and postnatal corticosteroids, or in terms of caffeine use and duration of mechanical ventilation and oxygen therapy. However, feeding intolerance (OR = 6.55; 95%CI 1.05-40.8) and length of gastric tube use (OR = 1.67; 95%CI 1.11-2.51) turned out to be risk factors for GERD. Postconceptual age at the time of pH monitoring (OR = 0.02; 95%CI < 0.001-0.38) was regarded as a protective factor against GERD. The data obtained allow inferring that prolonged gastric tube use and feeding intolerance increase the risk for GERD. On the other hand, older postconceptual age at the time of pH monitoring reduces the risk for GERD in preterm infants with bronchopulmonary dysplasia weighing less than 1,500 g.

Body mass index and GERD: Is the association that huge?

Body mass has been proposed as a modifiable risk factor for gastroesophageal reflux disease (GERD). Although this association makes intuitive sense, study results conflict. This article critically reviews the epidemiologic and mechanistic data surrounding the relationship between body mass index (BMI) and GERD, evaluates how the relationship may depend upon abdominal size, and explores potential alternative mechanisms through which body mass may influence the risk of GERD complications.

Association of body mass index with heartburn, regurgitation and esophagitis: Results of the Progression of Gastroesophageal Reflux Disease study

Overweight and obesity are believed to be risk factors for gastroesophageal reflux disease (GERD). The aim of the present study was to analyze the impact of body mass index (BMI) on the severity and frequency of reflux symptoms and esophagitis in a large cohort of reflux patients. As part of the Progression of Gastroesophageal Reflux Disease (ProGERD) study, 6215 patients with clinically assessed GERD were included in the present investigation (53% male, 52 +/- 14 years; 47% female, 56 +/- 14 years). Heartburn and regurgitation symptoms were assessed using the validated Reflux Disease Questionnaire. Endoscopies were performed and patients were subsequently classified as having non-erosive or erosive disease. To examine the association between BMI, GERD symptoms, and esophagitis, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression models. In patients with GERD, higher BMI was associated with more frequent and more severe heartburn and regurgitation, as well as with esophagitis. The effects were more pronounced for regurgitation than for heartburn. The strongest association was between obesity and severity of regurgitation symptoms (women: OR 2.11, 95%CI 1.60-2.77; men: OR 2.15, 95%CI 1.59-2.90). Obese women, but not men, had an increased risk of severe esophagitis compared to women with normal weight (OR 2.51, 95%CI 1.53-4.12). In patients with GERD, higher BMI was associated with more severe and more frequent reflux symptoms and esophagitis.

Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

瞄准：基于主要症状和内视镜的调查结果分析胃的食道的倒流疾病(GERD ) 的光谱和风险因素。方法：在一件簇随机样品的代表性的调查用一张验证中国版本倒流疾病问询表(RDQ ) 和记录人口统计的特征的另外的项目从 2004 年 11 月被进行到 2005 年 6 月，潜力为 GERD 冒因素的风险。题目被定义为根据 RDQ 分数有 GERD 症状(> 12 ) 。所有题目是 endoscopied 和定义，腐蚀食道炎的严厉被洛杉机分类评估。统计分析用 SPSS13.0 节目被执行。结果：2231 个招募的参加者， 701 (31.40%) 当时，病人们作为有 GERD 被诊断 464 (20.80%) 病人们有倒流食道炎(RE ) 的客观调查结果。那些 464 个病人，(13.00%) 仅仅， 291 与 GERD 症状作为题目被报导。病人们被发现有 GERD 症状的 528 的一个总数(23.70%) 包括有等级 A 或 B 倒流食道炎的 19.50% 病人， 0.90% 与等级 C 并且 0.40% 与等级 D。在上多，喝的变量分析，老年，男性，中等工作负担， divorced/widowed 和浓茶为腐蚀食道炎作为重要独立风险因素留下了。同时，油腻的食物和便秘的平淡的用法为非腐蚀的倒流疾病(书呆子) 被看作重要独立风险因素。结论：GERD 是有在中国的高出现率的普通官方补给的疾病之一，它的主要联系因素包括性别， anthropometrical 变量和 sociopsychological 特征。

Risk factors of gastroesophageal reflux disease in Shiraz, southern Iran

To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic, lifestyle and health-seeking behaviors in Shiraz, southern Iran. A total of 1978 subjects aged > 35 years who referred to Gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic, lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined. The prevalence of GERD was 15.4%, which was higher in females (17.3%), in rural areas (19.8%), and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%), and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%), taking aspirin (21%) and in subjects with psychological distresses (27.2%) and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%), dyspepsia (30.6%), anxiety (19.5%), nightmares (23.9%) and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%), consumption of herbal medicine (19%), using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%). GERD is more common in females, rural and illiterate subjects and correlated with consumption of pickles, occurrence of headache, psychological distress, dyspepsia, halitosis, anxiety, nightmare and restlessness, and a family history of GERD and aspirin intake, but the correlation was negative with consumption of fat and fiber intake.

Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

To analyze the spectrum and risk factors of gastroesophageal reflux disease (GERD) based on presenting symptoms and endoscopic findings. A cross-sectional survey in a cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version Reflux Disease Questionnaire (RDQ) and other items recording the demographic characteristics and potential risk factors for GERD. Subjects were defined as having GERD symptoms according to the RDQ score (> 12). All subjects were endoscopied and the definition and severity of erosive esophagitis were evaluated by Los Angeles classification. The statistical analysis was performed with SPSS13.0 programs. Of 2,231 recruited participants, 701 (31.40%) patients were diagnosed as having GERD while 464 (20.80%) patients had objective findings of reflux esophagitis (RE). Of those 464 patients, only 291 (13.00%) were reported as subjects with GERD symptoms. A total of 528 (23.70%) patients were found to have GERD symptoms, including 19.50% patients with grade A or B reflux esophagitis, 0.90% with grade C and 0.40% with grade D. On multivariate analysis, old age, male, moderate working burden, divorced/widowed and strong tea drinking remained as significant independent risk factors for erosive esophagitis. Meanwhile, routine usage of greasy food and constipation were considered as significant independent risk factors for non-erosive reflux disease (NERD). GERD is one of the common GI diseases with a high occurrence rate in China and its main associated factors include sex, anthropometrical variables and sociopsychological characteristics.

Lifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic Twins

Lifestyle and genetic factors dominate the etiology of gastroesophageal reflux disease. We investigated associations between lifestyle factors and gastroesophageal reflux (GER) symptoms, with and without controlling for genetic predisposition. In 1967 and 1973, questionnaires including lifestyle exposures were mailed to twins in the Swedish Twin Registry, and data on GER symptoms were collected by telephone interview during 1998-2002. Two analytic methods were used: external control analysis (4083 twins with GER symptoms and 21,383 controls) and monozygotic co-twin control analysis (869 monozygotic twin pairs discordant for GER symptoms). In the external control analysis, leanness (body mass index [BMI] <20), upper normal weight (BMI 22.5-24.9), overweight (BMI 25-29.9), and obese (BMI > or =30) conferred -19%, 25%, 46%, and 59% increased risk of frequent GER symptoms compared with normal weight (BMI 20-22.4), respectively, among women, whereas no such associations were evident among men. When adjusted for genetic and nongenetic familial factors, these estimates were -28%, 44%, 187%, and 277%, respectively, among men. Frequent smoking rendered a 37% increased risk of frequent GER symptoms among women and 53% among men compared with nonsmokers. Physical activity at work was dose dependently associated with increased risk of frequent GER symptoms, and recreational physical activity decreased this risk. BMI, tobacco smoking, and physical activity at work appear to be risk factors for frequent GER symptoms, whereas recreational physical activity appears to be beneficial. Association between BMI and frequent GER symptoms among men seems to be attenuated by genetic factors.

Risk Factors for Gastroesophageal Reflux Disease (GERD) in Children

Risk Factors for Gastroesophageal Reflux Disease (GERD) in Children

Epidemiology and Risk Factors for Gastroesophageal Reflux Disease (GERD) in Italy

Epidemiology and Risk Factors for Gastroesophageal Reflux Disease (GERD) in Italy

Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma

The aim of this study was to examine the association of obesity with esophageal adenocarcinoma, and with the precursor lesions Barrett esophagus and gastroesophageal reflux disease (GERD). This case-control study included cases with GERD (n = 142), Barrett esophagus (n = 130), and esophageal adenocarcinoma (n = 57). Controls comprised 102 asymptomatic individuals. Using logistic regression methods, we compared obesity rates between cases and controls adjusting for differences in age, gender, and lifestyle risk factors. Relative to normal weight, obese individuals were at increased risk for esophageal adenocarcinoma (Odds Ratio [OR] 4.67, 95% Confidence Interval [CI] 1.27-17.9). Diets high in vitamin C were associated with a lower risk for GERD (OR 0.40, 95% CI 0.19-0.87), Barrett esophagus (OR 0.44, 95% CI 0.20-0.98), and esophageal adenocarcinoma (OR 0.21, 95% CI 0.06-0.77). For the more established risk factors, we confirmed that smoking was a significant risk factor for esophageal adenocarcinoma, and that increased liquor consumption was associated with GERD and Barrett esophagus. In light of the current obesity epidemic, esophageal adenocarcinoma incidence rates are expected to continue to increase. Successful promotion of healthy body weight and diets high in vitamin C may substantially reduce the incidence of this disease.

Novel developments in non-erosive and erosive gastroesophageal reflux disease

Despite being clinically important and highly prevalent, several aspects of gastroesophageal reflux disease are incompletely understood. Research activity remains high, however, and we shall review some highlights from last year's publications. Community based epidemiological studies have elucidated the risk factors for gastroesophageal reflux disease and demonstrated a significant risk for developing complications over time. New histological parameters such as distended intercellular spaces in the epithelium will detect minor signs of reflux damage. The esophageal endoscopic capsule has been studied as a way of screening for esophageal disease. Wireless pH-metry and impedance-pH-metry have increased our insight into the pathophysiology and improved the diagnostic work-up in atypical and therapy resistant cases. At the molecular level, the role of cytokines has been elucidated and there is increased support for the nitrosative stress theory for epithelial damage at the cardia. Endoscopic therapies have shown disappointing long-term results or safety concerns, leading to withdrawal of several methods. The last year has brought significant development in diagnostic modalities, and increased our insight in the molecular events involved in the pathogenesis of gastroesophageal reflux disease. Ultimately, this may and must lead to new therapeutic modalities which will supplement proton pump inhibitors in medical therapy for gastroesophageal reflux disease.

The incidence of hiatal hernia, reflux esophagitis and Barrett's esophagus between 2003 and 2005

Introduction: It has been suggested that hiatus hernia (HH) is an important etiological factor for gastro-esophageal reflux disease (GERD).