Use Of H2 Blockers Research Articles

Recent advances in prevention of sepsis in the premature neonates in NICU

Sepsis-related morbidity and mortality are major problems in NICU. Preterm neonates display clinical characteristics that make them prone to infections. Due to the high frequency of severe neurodevelopmental sequelae in survivors, the best possible strategy to manage sepsis in NICU is to prevent them. Hygiene, cohorting, stewardship on use of H2-blockers, steroids and broad-spectrum antibiotic are mandatory, as well as proper management of central venous accesses and surgical devices. In addition, clinical research offers the opportunity of adopting pharmacological preventative strategies such as use of palivizumab to prevent RSV infection, use of fluconazole to prevent fungal sepsis, use of probiotics and lactoferrin to enhance the innate immunity, and use of pagibaximab to prevent staphylococcal sepsis.

Factors associated with irritable bowel syndrome symptoms in hemodialysis patients

To investigate clinical characteristics associated with the presence of irritable bowel syndrome (IBS) symptoms in hemodialysis (HD) patients. This was a cross-sectional study. A questionnaire based on the Bowel Disease Questionnaire that records gastrointestinal symptoms was given to 294 patients in 4 dialysis centers. A total of 196 (67%) subjects returned the survey. A multivariable logistic regression model was used to identify factors significantly associated with IBS symptoms. Symptoms compatible with IBS were present in 27 (13.8%) subjects and independently associated with low post-dialysis serum potassium [OR = 0.258, 95% CI (0.075-0.891), P = 0.032], paracetamol use [OR = 3.159, 95% CI (1.214-8.220), P = 0.018], and Kidney Disease Quality of Life (KDQOL) cognitive function score [OR = 0.977, 95% CI (0.956-0.999), P = 0.042]. Univariate regressions were also performed and the reported significance is for multivariate analysis. No association was detected for age, gender, depressed mood, smoking (present or past), body mass index, albumin level, Kt/V, sodium pre- or post-dialysis level, change in potassium level during HD, proton pump inhibitor or H2 blocker use, aspirin use, residual diuresis, hepatitis B or C infection, diabetes mellitus, marital status and education level. This study examined potential risk factors for symptoms compatible with IBS in HD patients and identified an association with paracetamol use, post-dialysis potassium level and KDQOL-cognitive function score.

PP-149. Resistance of bacterial isolates in newborn infants treated at Portuguese NICUs

Infants in neonatal intensive care units (NICUs) are highly susceptible to infection due to the immaturity of their immune systems. Healthcare-associated infections (HCAIs) are associated with prolonged hospital stay, and represent a significant risk factor for neurological development problems and death. Improving HCAI control is a priority for NICUs. Many factors contribute to the occurrence of HCAIs in neonates such as poor hand hygiene, low nurse–infant ratios, environmental contamination and unnecessary use of antibiotics. Prevention is based on improving neonatal management, avoiding unnecessary use of central venous catheters, restricting use of antibiotics and H2 blockers, and introducing antifungal prophylaxis if necessary. Quality improvement interventions to reduce HCAIs in neonates seem to be the cornerstone of infection control.

Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study

To examine whether use of proton pump inhibitors (PPIs) and H2 blockers is associated with increased pneumonia risk. We conducted a population-based, nested case-control study within Group Health, an integrated healthcare delivery system. Among community-dwelling, immunocompetent adults aged 65-94, we identified presumptive cases of ambulatory and hospitalized community-acquired pneumonia in 2000-2003 from ICD-9 codes and validated them by medical record review (N = 1125). Controls were selected, matched to cases on age, sex, and calendar year (N = 2235). Current PPI or H2 blocker use was ascertained from computerized pharmacy records. Comorbid illnesses and other characteristics were ascertained by medical record review. Multivariable conditional logistic regression was used to examine the association between medication use and pneumonia risk. We conducted sensitivity analyses using only administrative and pharmacy data to assess how these results differed from our primary results. The prevalence of PPI or H2 blocker use was 21% (241/1125) for pneumonia cases and 16% (350/2235) for controls (adjusted odds ratio [OR] 1.03, 95% CI 0.86-1.24, compared to nonuse). No increased risk was seen for recent initiation. The prevalence of PPI use was 12% (132/1125) for cases and 7% (160/2235) for controls (adjusted OR 1.13, 95% CI 0.88-1.44). Analyses using only administrative and pharmacy data yielded risk estimates farther from the null (adjusted OR 1.32, 95% CI 1.17-1.49, for current PPI use versus nonuse). Use of PPIs and H2 blockers is not associated with increased pneumonia risk in older adults. The increased risk observed in some prior studies may reflect confounding.

S1229 Risk Factors for Recurrent Clostridium difficile-Associated Diarrhea: A Retrospective Case-Control Study

KUB showing colonic dilatation (p=0.002) and use of H2 blocker (p=0.03) but not PPIs independently predicted need for ICU care. On multivariate analysis, hemodialysis (p 100 (p<0.02) and colonic dilatation (p<0.02), remained significantly associated with admission to the ICU. Conclusions: Communityacquired CDAD in a major metropolitan inner city population is less severe than hospitalacquired CDAD. The disease is more frequently seen in women and the likelihood of ICU admission can be predicted by various factors on admission.

Strategies to Limit Infections in the Neonate and to Reduce Infection-related Mortality

Health-care associated infections remain a major problem in the neonatal intensive care unit (NICU), resulting in significant morbidity and mortality. Specifically, bloodstream infections have been associated with adverse neurodevelopmental outcomes among preterm infants with birth weight <1000 grams. In addition, these infections are associated with prolonged duration of hospitalization among survivors and increased cost of neonatal health care. It is clear that preventive strategies are urgently needed. Many bloodstream infections in the NICU are associated with the use of central venous catheters, and implementation of evidence-based measures as well as bundles has reduced their occurrence. Nevertheless, much work remains. Candidal infections have become more prevalent in the NICU, and fluconazole prophylaxis is being recommended and used to prevent candidiasis among infants with birth weight <1000 grams. Although fluconazole prophylaxis has reduced invasive candidal infections, the underlying risk factors that result in Candida becoming a more common pathogen remain, namely the overuse of antibiotics especially the third generation cephalosporins. In addition, the use of H2 blocker also has contributed to Candidal colonization and late onset sepsis. Recent results of randomized clinical trials have shown beneficial effects of probiotics for prevention of necrotizing enterocolitis and lactoferrin for prevention of late onset sepsis. Finally, the need to vaccinate not only our preemies but also staff and family members of babies in the NICU will further reduce the likelihood of introducing community-associated pathogens into the NICU. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Lactoferrin and prevention of late-onset sepsis in the pre-term neonates

Late-onset sepsis (LOS) affects a large proportion of pre-term neonates in neonatal intensive care units (NICUs) worldwide, with high morbidity and related mortality, and frequent occurrence of severe late neurodevelopmental impairment. Due to the frequency, severity and difficulties in early diagnosis and prompt therapy, prevention is crucial for decreasing the burden of infection-related complications in NICUs. It is well known that feeding with fresh maternal milk, hygiene measures and the cautious use of H2-blockers are related with a decreased risk of developing sepsis. However, evidence from randomised clinical trials exists only for fluconazole in the prevention of fungal infections in the NICU. Lactoferrin is the main whey protein in mammalian milk, and is involved in innate immune host defences. Notably, human lactoferrin can be found at increased concentrations in colostrum and in milk from mothers of premature neonates. Human (hLF) and bovine lactoferrin (bLF) share a high (77%) amino-acid homology, and the same N-terminal peptide responsible for antimicrobial activity, called lactoferricin. In vitro, bLF shows potent direct antimicrobial activity against all types of pathogens, which occurs via anti-cell wall actions and leads to disintegration of the micro-organism's membranes. bLF is also synergistic with many antimicrobials and antifungals, and promotes growth and differentiation of the immature gut. Based on this background data, a randomised clinical trial was recently conducted in very low birth weight pre-term neonates given bLF alone or with the probiotic Lactobacillus GG. The aim of the trial was to assess the ability of bLF to prevent late-onset sepsis of any origin in the studied infants during their stay in the NICU. This article discusses the preliminary data from this study, along with the proposed mechanisms of action of bLF in pre-term infants.

Trends in Gastroesophageal Reflux Disease as Measured by the National Ambulatory Medical Care Survey

The prevalence of reflux disease is increasing. Health-care utilization including physician visits for this disorder is lacking. Our purpose was to analyze the trend in physician visits for GERD from the period 1995-2006 using the National Ambulatory Medical Care Survey. We also sought to determine health-care utilization for GERD indirectly by assessing prescription trends for proton-pump inhibitors and H2 receptor blockers during the period. The National Ambulatory Medical Care Survey is a survey of approximately 3,000 office-based physicians that uses a three-stage probability sampling procedure to allow extrapolation to the US population. All visits between 1995 and 2006 for symptoms and/or diagnoses compatible with GERD were combined into a single categorical variable. Weighted data was utilized for descriptive and inferential statistical analysis. After weighting, there were N = 321,513 adult ambulatory care encounters for all diagnoses. Visits for reflux increased throughout the examined period. Using logistic regression, visits for reflux were associated with female gender, age over 40, and calcium channel blocker use. Proton-pump inhibitor use increased substantially during the study period while H2 blocker use declined. Family practitioners and internists saw the majority of reflux patients. The frequency of ambulatory visits in the United States for gastroesophageal reflux disease increased significantly between 1995 and 2006. The use of PPI therapy is increasing even more substantially. Older age, female gender, and use of calcium channel blockers were associated with a higher frequency of GERD visits. Health-care utilization for this disorder is increasing perhaps due to our ever-increasing epidemic of obesity.

Correlation between docetaxel-induced skin toxicity and the use of steroids and H2 blockers: A multi-institution survey

9536 Background: Docetaxel is a standard drug used for adjuvant or neoadjuvant chemotherapeutic treatment of early breast cancer. With appropriate management of chemotherapy-induced bone marrow toxicity, skin toxicities such as hand-foot syndrome (HFS) and facial erythema (FE) have become dose-limiting. Steroids and H2 blockers are commonly used to provide supportive care to patients being treated with taxane-containing chemotherapeutic regimens, but their effects on skin toxicity are poorly understood. Methods: We asked institutions belonging to the JBCRG to complete a questionnaire regarding the occurrence of grade 2 or higher HFS and FE among patients treated with docetaxel as an adjuvant or neoadjuvant chemotherapeutic treatment for breast cancer between April 2007 and March 2008. Data collected were docetaxel dose, other chemotherapeutic agents administered, dosage regimens for the steroids and H2 blockers (if used), and incidences of grade 2 or higher HFS or FE. Statistical analyses were performed using the chi-squared test. Results: We obtained data for 989 patients from 22 institutions. Most patients received docetaxel at a dose of 75 mg/m2 and 852 patients were treated with docetaxel monotherapy. HFS and FE occurred in 18% and 13% of patients, respectively. The relationships between the incidence of skin toxicity and (i) chemotherapy regimen and (ii) use of H2 blockers are shown below ( Table ). Conclusions: Our data suggest that use of H2 blockers as premedication in breast cancer patients treated with docetaxel significantly increases the risk of both HFS and FE. [Table: see text] [Table: see text]

Colorectal cancer risk in relation to use of acid suppressive medications

Acid suppressants are commonly prescribed medications. Laboratory studies suggest a mechanism by which they could increase colorectal cancer (CRC) risk. A few epidemiologic studies have investigated acid suppressant use and CRC risk; none has documented an overall association. We sought to investigate whether acid suppressants are associated with CRC risk. We conducted a case-control study among members of an integrated healthcare delivery system in Washington State. Cases (N = 641) were diagnosed with CRC between 2000 and 2003; controls (N = 641) were randomly selected from enrollees and matched to cases on age, sex, and length of enrollment. We used conditional logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for CRC associated with the use of any acid suppressive medication, proton pump inhibitors (PPIs) only, histamine receptor antagonists (H2 blockers) only, or both PPIs and H2 blockers in relation to the use of neither PPIs nor H2 blockers. Use of PPIs exclusively was modestly associated with an increased risk of CRC, however this finding was consistent with chance and based on a small number of patients exposed (OR = 1.7; 95%CI = 0.8, 4.0). H2 blocker use alone was not related to CRC risk (OR = 0.8; 95%CI = 0.6, 1.1). PPI use may be modestly associated with CRC risk; further research should be conducted in populations with long-term PPI use.

Examination of Selected Clinical Factors and Medication Use as Risk Factors for Pneumonia During Stroke Rehabilitation

To assess the association of selected clinical factors and specific medication use (proton pump inhibitors, H2 receptor antagonists [H2 blockers], and angiotensin-converting enzyme inhibitors) with presence of pneumonia in patients with stroke undergoing acute inpatient rehabilitation. Matched case-control study in a freestanding urban academic inpatient acute rehabilitation hospital. Participants were 72 stroke survivors, consisting of 36 patients who developed pneumonia during rehabilitation hospitalization individually matched in order of decreasing priority on age, sex, stroke side, depth, and severity with 36 patients with stroke not developing pneumonia. Potential risk factors, including severe dysphagia, dietary interventions, presence of tracheostomy or feeding tube, and specific medications, were assessed for association with pneumonia during rehabilitation using separate univariate and multivariate analyses. Functional change was assessed using the functional independence measure. Although pneumonia was associated with proton pump inhibitors or H2 blockers (odds ratio, 3.3; 95% confidence interval, 1.0-13.7), any feeding tube (odds ratio: 5.0; 95% confidence interval, 1.4-27.0), severe dysphagia (odds ratio: 15.0; 95% confidence interval, 2.3-631), and tracheostomy (odds ratio: 10; 95% confidence interval, 1.4-434.0) on univariate evaluation, none of these individual factors was significantly associated with pneumonia in a multivariate model. Risk factors were found to be highly related to each other. Odds of pneumonia did not significantly decrease with angiotensin-converting enzyme inhibitors (odds ratio: 0.9; 95% confidence interval, 0.2-3.0). Patients with pneumonia had a significantly lower functional independence measure score at discharge. A reduction in pneumonia was not found with the use of angiotensin-converting enzyme inhibitors. Although tracheostomies, feeding tubes, proton pump inhibitor or H2 blocker use, and the presence of dysphagia were identified as risk factors for pneumonia on univariate analyses, none of these factors demonstrated an independent association with pneumonia on multivariate analyses. It may be more that the underlying impairment, rather than the assessed interventions, may confer greater risk of pneumonia in the poststroke patient.

Abstract 2026: Incidence, Predictors and Outcome of Upper Gastrointestinal Bleeding in Patients with Acute Coronary Syndromes

Purpose: The broad utilization of revascularization and antithrombotic drugs has improved outcome of patients with acute coronary syndromes (ACS). Nevertheless, these strategies are associated with a substantial risk of bleeding, which is associated in turn with increased mortality. Most bleeding episodes are related to arterial punctures. The characteristics and outcome of patients who develop upper gastrointestinal bleeding (UGIB) in this setting have received little attention. Methods: Using computerized databases we identified all patients admitted to our center between 10/96 and 11/07 for an ACS who developed UGIB during their hospital stay. For each case 3 control cases matched for age, gender, and ACS subtype were randomly selected. Multiple baseline characteristics, as well as antithrombotic agents, revascularization strategy, endoscopy reports and 30-day mortality were recorded. Results: 7240 ACS patients were admitted to our ICCU during the study period, of whom 64 (0.9%) developed UGIB. There were no significant differences between groups in the prevalence of diabetes and other risk factors, revascularization strategy, or the use of proton pump inhibitors or H2-blockers. Patients who bled suffered more from renal impairment and LV dysfunction and were more frequently treated with thienopyridines (89% vs. 68%, p=0.002) and GPIIb/IIIa receptor blockers (39% vs. 24%, p=0.03), but were treated equally with aspirin (100% vs. 96%, p=0.2). The combination of unfractionated heparin (UFH) with either GP IIb/IIIa receptor blockers or enoxaparin was also associated with UGIB (30% vs. 7%, p=0.001 and 36% vs. 18%, p=0.005, respectively). Patients who developed UGIB had a substantially higher 30-day mortality rate (33% vs. 6%, p&lt;0.001). Among patients for whom endoscopy was available (35 patients of 64) the source of bleeding was similarly distributed between the esophagus, stomach and duodenum. Gastritis and duodenitis were the most common findings. Conclusions: UGIB in patients with ACS is associated with very high mortality. Patients who bled tended to have a greater degree of cardiac and renal dysfunction. The use of combined anti-platelet therapy, especially in conjunction with UFH is a strong risk factor for this serious complication.

Increasing Incidence ofClostridium difficile-associated Disease, Singapore

Increasing Incidence of<i>Clostridium difficile</i>-associated Disease, Singapore

Effect of Heartburn on Life Expectancy

Effect of Heartburn on Life Expectancy

Gastric Acid Suppression and the Risk of Enteric Peritonitis in Peritoneal Dialysis Patients

Peritonitis caused by enteric organisms in peritoneal dialysis (PD) patients is associated with greater morbidity and mortality than peritonitis with non-enteric organisms. One reported risk factor for enteric peritonitis (EP) is gastric acid suppression, with two small studies providing conflicting results. The objective of this study was to determine, using a larger patient population, whether gastric acid suppressants are associated with an increased risk of EP. Using a single-center case-control design, information on episodes of EP occurring between 2003 and 2006 was collected. Control episodes were all non-enteric episodes of peritonitis that occurred during the same time interval. Proton pump inhibitor (PPI) or H(2)-blocker (H(2)B) use prior to development of peritonitis was documented. A total of 228 peritonitis episodes among 137 patients met inclusion criteria. In 32% of episodes, the causative organism was enteric. Gastric acid suppressant use was documented in 46% of episodes, with the majority on PPIs. Overall, gastric acid suppression was not associated with a higher EP risk (p = 0.17). In a post hoc analysis, PPIs were not associated with EP [odds ratio (OR) 1.3, 95% confidence interval (CI) 0.7-2.4; p = 0.42], whereas H(2)Bs were associated with a higher risk of EP (OR 2.9, 95% CI 1.1-7.7; p = 0.04), although the number of patients on H(2)Bs was small. Overall, gastric acid suppression was not associated with an increased risk of peritonitis with enteric organisms. While PPI use appears to be safe for PD patients with appropriate indications, the potential risk of EP with H(2)Bs requires further investigation.

Do Acid-Lowering Agents Affect Vitamin B12 Status in Older Adults?

To examine the relationship between serum vitamin B12 levels in older adults on histamine(2) receptor antagonists (H2 blockers) or proton-pump inhibitors (PPI) over 6 years. A cross-sectional sample of 659 adults, 60 to 102 years, from long-term care facilities and community ambulatory care (C) in the Bronx. Patient demographics, serum B12 levels, use and duration of use of H2 blockers, PPIs, antacids, multivitamin/minerals, liquid dietary supplements, oral vitamin B12 supplementation, oral or intramuscular B12 therapy, and recent lab chemistries. Acid-lowering agents (ALA) were used by 54% (PPIs by 26% and H2 blockers by 28%), duration averaged 18.2 +/- 16.0 (SD) months. NH and C subjects had similar ages (P = .9971), gender distributions (P = .625), durations of ALA use (P = .1227), and rates of PPI use (P = .130); NH subjects used more H2 blockers (P < .0005) and had less low B12 status (P = .037). H2 blocker use did not influence serum B12 status (P = .1036) while PPI use was associated with diminished serum B12 levels (P < .00005). Concomitant oral B12 supplementation slowed but did not prevent the decline in B12 status during prolonged PPI use (P = .0125). B12 status declines during prolonged PPI use in older adults, but not with prolonged H2 blocker use; supplementation with RDA amounts of B12 do not prevent this decline. This report reinforces that B12 deficiency is common in the elderly and suggests that it appears prudent to monitor periodically B12 status while on prolonged PPI use, to enable correction before complications ensue.

Relationship between Histamine2-Receptor Antagonist Medications and Risk of Invasive Breast Cancer

Histamine(2)-receptor antagonist (H(2) blocker) medications are used to treat heartburn, gastroesophageal reflux disease, and ulcers. Some H(2) blockers, specifically cimetidine and ranitidine, also increase serum prolactin concentrations. Given the positive relationship between prolactin levels and postmenopausal breast cancer risk, use of H(2) blockers is a potential breast cancer risk factor. The few previous studies evaluating this association have been null but have been limited by small sample sizes, and none have evaluated risk by either histologic type or estrogen receptor/progesterone receptor status. Combining data from two population-based case-control studies conducted in western Washington, we assessed the relationship between use of H(2) blockers and risk of different types of breast cancer among 1,941 cases and 1,476 controls 55 to 79 years old. Odds ratios and 95% confidence intervals (95% CI) were calculated using polytomous logistic regression. Current use of H(2) blockers overall, cimetidine, and famotidine was not associated with an increased risk of either invasive ductal or invasive lobular breast cancer. Current users of ranitidine had a 2.2-fold (95% CI, 1.1-4.3) increased risk of ductal carcinoma that was confined to a 2.4-fold (95% CI, 1.2-4.9) increased risk of estrogen receptor-positive/progesterone receptor-positive ductal carcinoma. Use of H(2) blockers in general is not associated with an increased risk of breast cancer, although current use of ranitidine may increase risk of hormone receptor-positive ductal carcinoma. Further studies to confirm this finding are warranted.

Helicobacter pylori Gastritis in Children Is Associated With a Regulatory T-Cell Response

Helicobacter pylori infection in children infrequently causes gastroduodenal mucosal ulceration. Because H pylori induces T-cell dependent gastric inflammation in adults and T regulatory (Treg) cells suppress T-cell-dependent pathology, we evaluated gastric histopathology and Treg cell responses in H pylori-infected children and adults. Gastric tissue from 36 children and 79 adults with abdominal symptoms in Santiago, Chile, was evaluated prospectively for H pylori bacteria and histopathology using the Sydney classification and Treg responses using immunoassay, immunohistochemistry, and real-time polymerase chain reaction. Eighteen (50%) of the children and 51 (65%) of the adults were infected with H pylori. Children and adults were colonized with similar levels of H pylori. However, the level of gastritis in the children was reduced substantially compared with that of the adults (P < .05). Coincident with reduced gastric inflammation, the number of Treg cells and levels of Treg cytokines (transforming growth factor [TGF]-beta1 and interleukin-10) were increased markedly in the gastric mucosa of H pylori-infected children compared with that of infected adults (P < .03 and < .05, respectively). Also, H pylori infection in the children was associated with markedly increased levels of gastric TGF-beta1 and interleukin-10 messenger RNA. Importantly, gastric TGF-beta1 in H pylori-infected children localized predominantly to mucosal CD25(+) and Foxp3(+) cells, indicating a Treg source for the TGF-beta1. Gastric pathology is reduced and local Treg cell responses are increased in H pylori-infected children compared with infected adults, suggesting that gastric Treg cell responses down-regulate the inflammation and ulceration induced by H pylori in children.

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units

Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

Gastroesophageal Reflux Disease as a Cause of Death Is Increasing: Analysis of Fatal Cases After Medical and Surgical Treatment

The population impact of modern treatment on complicated gastroesophageal reflux disease (GERD) is not well understood. Our aim was to determine the current mortality from GERD in Finland and compare this with the use of health resources. In this population-based retrospective study, Finland's administrative databases provided figures on the nationwide use of antireflux medication, rate of antireflux surgery, and mortality from GERD. Any deceased person included had classic symptoms as well as objective findings of GERD. After analysis of the medical records of 306 patients, 213 were included. Annual mortality from GERD increased (P < 0.001) from 0.18/100,000 in 1987 to 0.46/100,000 in 2000. During that time, use of H2-blockers and proton pump inhibitors and the annual rate of antireflux surgery increased significantly (P < 0.001). Mortality from antireflux surgery, including fundoplication and gastric and esophageal resection, remained around 1.9/1,000 operations. Of the 213 patients whose cause of death was considered to be GERD, 180 (85%) had received medical treatment, including 4 patients whose death was related to either diagnostic or therapeutic endoscopy. Early complications of antireflux surgery caused 24 (11%) deaths; 9 (4%) were late failures of antireflux surgery. Causes of death in the medical group were hemorrhagic esophagitis (82, 47%), aspiration pneumonia (41, 23%), ulcer perforation (25, 14%), rupture with esophagitis (15, 9%), and stricture (13, 7%). Regardless of the increased use of health resources, mortality from GERD, especially with medical treatment, rose. Surgery for GERD was also associated with early mortality and usually could not prevent the fatal outcome.