GERD linked to nontuberculous mycobacteria pulmonary disease development

Key takeaways:

• Nontuberculous mycobacteria pulmonary disease occurred in more patients with GERD.
• Risk factors for this disease included being at least 60 years old and having bronchiectasis.

Patients with GERD experienced more incidences of nontuberculous mycobacteria pulmonary disease than patients without GERD, according to study results published in CHEST.

“GERD was shown to be an important predisposing factor for the development of nontuberculous mycobacteria pulmonary disease, and older age and bronchiectasis were risk factors for incident nontuberculous mycobacteria pulmonary disease in patients with GERD,” Youlim Kim, MD, PhD, of the division of pulmonary, allergy and critical care medicine at Konkuk University School of Medicine, and colleagues wrote. “Nontuberculous mycobacteria pulmonary disease developing in patients with GERD is associated with increased health care use.”

In a population-based longitudinal cohort study, Kim and colleagues analyzed 17,424 adults with GERD (26.3% aged 50 to 59 years; 50.1% men) between 2002 and 2015 from the Korean National Health Insurance Service National Sample Cohort to determine if GERD plays a role in nontuberculous mycobacteria pulmonary disease development. They also sought to identify risk factors linked to nontuberculous mycobacteria pulmonary disease in this patient population and how the prevalence of ED/hospital visits changes with the disease.

Using age, sex, insurance type and Charlson Comorbidity Index variables, researchers matched GERD patients with control patients (n = 69,696; 26.3% aged 50 to 59 years; 50.1% men) to assess differences in the two cohorts. The median follow-up period was 5.1 years.

When assessing incidence rates after adjusting for age and sex, patients with GERD showed more instances of nontuberculous mycobacteria pulmonary disease vs. control patients (34.8 per 100,000 patient-years vs. 10.5 per 100,000 patient-years).

Assessment against matched patients further showed a 3.4-fold (subdistribution HR = 3.36; 95% CI, 2.1-5.37) higher risk for nontuberculous mycobacteria pulmonary disease in patients with GERD, according to researchers.

For factors linked to a heightened risk for nontuberculous mycobacteria pulmonary disease among patients with GERD, researchers identified two during univariate and multivariate analysis: age of at least 60 years (aHR = 3.57; 95% CI, 1.58-8.07) and bronchiectasis (aHR = 18.69; 95% CI, 6.68-52.28).

Additionally, patients with GERD and nontuberculous mycobacteria pulmonary disease had more instances of all-cause ED/hospital visits than patients with GERD and no further disease (13,321 per 100,000 patient-years vs. 5,932 per 100,000 patient-years; P = .049). More specifically, patients with both diseases also had a greater number of respiratory disease-related ED/hospital visits (5,403 per 100,000 patient-years vs. 801 per 100,000 patient-years; P = .011).

With these findings, Kim and colleagues brought attention to three possible clinical implications.

“First, because the risk of nontuberculous mycobacteria pulmonary disease in patients with GERD was significantly higher than in those without GERD, nontuberculous mycobacteria pulmonary disease should be suspected when new-onset or worsening of respiratory symptoms develop during regular follow-up in patients with GERD,” Kim and colleagues wrote. “Second, because the results indicate that older age and bronchiectasis significantly increased the risk of nontuberculous mycobacteria pulmonary disease, more active strategies (eg, screening of symptoms and regular chest radiography follow-up) may be helpful in patients with GERD and these risk factors.

“Third, patients with GERD who demonstrated nontuberculous mycobacteria pulmonary disease made more respiratory disease-related ED visits and were hospitalized more often than those who did not demonstrate nontuberculous mycobacteria pulmonary disease,” they added. “Thus, when GERD and nontuberculous mycobacteria pulmonary disease are combined, clinicians should focus on the variations of respiratory symptoms.”