Anti-reflux lifestyle leads to decreased risk for GERD symptoms in women
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Women who adhered to an anti-reflux lifestyle had a decreased risk for gastroesophageal reflux disease symptoms, possibly preventing up to 40% of symptoms that occur weekly, according to study results.
“Adherence to an anti-reflux lifestyle, even among regular users of PPIs and/or [H2 receptor antagonists], was associated with a decreased risk of GERD symptoms and may prevent nearly 40%of GERD symptoms that occur at least weekly,” Raaj S. Mehta, MD, from the Clinical and Translational Epidemiology unit, Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues wrote. “[GERD] is more common in white women aged 30 to 60 years. These data support the importance of lifestyle modification in management of GERD symptoms.”
Mehta and colleagues used the Nurses’ Health Study II to identify 42,955 women with acid reflux. Investigators calculated the anti-reflux lifestyle score, which included five variables: normal weight; never smoking; moderate to vigorous physical activity for 30 minutes daily; no more than 2 cups of coffee, tea or soda daily and a prudent diet.
“Women were considered to have GERD symptoms if they reported acid reflux or heartburn at least weekly, as in previous studies,” Mehta and colleagues wrote. “Person-years of follow-up accrued from the date of return of the 2007 questionnaire (starting June 1, 2007) to the first report of GERD, death, or end of follow-up (June 1, 2017), whichever came first.”
Researchers calculated the population-attributable risk for GERD symptoms attributable to the five lifestyle factors by estimating relative risk for multivariable logistic regression models controlled for other covariates.
Results showed 9,291 incident cases of GERD symptoms observed during 392,215 person-years of follow-up.
“Compared with women without adherence to anti-reflux lifestyle factors, the multivariable HR for GERD symptoms was 0.50 (95% CI, 0.42-0.59) for those with [five] anti-reflux lifestyle factors,” the investigators wrote. “The proportion of cases of GERD symptoms that may be prevented by all five factors included in the anti-reflux lifestyle score was 37% (95% CI, 28%-46%).”
According to researchers, each lifestyle factor was independently correlated with GERD symptoms.
“We considered the possibility that initiation of PPI and/or H2RA treatment during follow-up may have influenced our results,” Mehta and colleagues wrote. “We conducted analyses in which we considered use of these agents to indicate the presence of GERD symptoms and observed consistent results.”
Investigators performed an additional analysis of 3,625 women who reported regular use of PPIs and/or H2Ras and did not have GERD symptoms at baseline. Women with the five factors had a multivariable-adjusted HR of 0.32 for GERD symptoms vs. women who used PPI and/or H2RA without anti-reflux lifestyle factors.
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Prashanthi N. Thota, MD, FACG
This study provides strong evidence that lifestyle modifications – namely, normal weight; never smoking; moderate to vigorous physical activity for 30 minutes daily; no more than two cups of coffee, tea or soda daily and a prudent diet – reduce GERD symptoms not only in patients who are not on any acid suppressive medications but also on those who are taking the medications. It is an important adjunct to medical management of GERD in women. It is not known if an adoption of these lifestyle measures leads to a decrease in the symptoms.
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