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Increased estrogen use, dosage associated with increased risk for GERD symptoms
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Postmenopausal hormone therapy use was associated with symptoms of gastroesophageal reflux in postmenopausal women in a recently published study.
Researchers from Boston University and other sites in Massachusetts and Missouri conducted a prospective cohort study, using data from the Nurses’ Health Study, to determine the relationship between postmenopausal HT use and symptoms of gastroesophageal reflux disease. HT included estrogen receptor modulators and over-the-counter preparations.
The study included 51,637 postmenopausal women, 12,018 of whom reported heartburn and acid reflux at least once per week.
Past HT users had a multivariate OR of 1.46 for the risk of gastroesophageal reflux symptoms. Multivariate OR was 1.66 for current users of estrogen only and 1.41 for users of combined estrogen and progesterone. The researchers reported a relationship between an increased risk for gastroesophageal reflux symptoms and increases in estrogen dosage (P<.001) and duration of estrogen use (P<.001).
The OR for the risk of gastroesophageal reflux symptoms was 1.39 among current users of selective estrogen receptor modulators (95% CI, 1.22-1.59) and 1.37 for those currently using over-the-counter preparations (95% CI, 1.16-1.62).
Based on their findings, the researchers wrote, “this suggests a hormonal component to the pathophysiologic characteristics of gastroesophageal reflux in women.” – by Stacey L. Adams
Arch Intern Med. 2008;168:1798-1804.
The Nurses’ Health Study has been a wonderful source of health information; it is an ongoing cohort study that has allowed many health questions to be explored. The researchers point out an association between gastroesophageal reflux and HT use in 2002. They suggest that dose may be important, and they find that selective estrogen receptor modulators and different forms of HT are associated. Details, however, are unclear. Careful reading suggests that the researchers do not make it clear how many variables of interest were known simultaneously to assess associations during the longitudinal follow-up.
As such, this appears to be a predominantly cross-sectional prevalence association study looking for associations of variables present in 2002. It is difficult to know from the writing how complete the data really are. If the data are mostly all prevalence data, it provides a hypothesis that hormonal effects on the gastrointestinal track may be etiologically important. Of interest would be associations with weight gain during the longitudinal follow-up, after controlling for all variables observed simultaneously through time.
Interactions of HT use with weight gain over many years for the complete data set are of strong interest. If all variables during the longitudinal follow-up in the cohort study design were accessible, then this would lend more credence to their hypothesis. Hormonal effects of gastrointestinal motility and on any smooth muscle in the body have been known for a long time. The issue is this: what is the magnitude of the effect compared to other risk factors and other potential mechanisms thought to be important in creating gastroesophageal reflux? Randomized studies looking at the effects of these interventions assessing gastroesophageal reflux are of keen interest.
– Robert A. Wild, MD, PhD, MPH
Professor of Reproductive Endocrinology
Oklahoma
University Health Sciences Center, Oklahoma City