History of GERD in the Community and Its Effect on Survival
History of GERD in the Community and Its Effect on Survival
Background Gastro-oesophageal reflux symptoms (GERS) are common in the community. However, few studies have examined their long-term natural history, or impact on survival.
Aim To examine these issues in individuals recruited into a community-based screening programme for Helicobacter pylori in 1994.
Methods Data on mortality and cause of death at 10 years were obtained from the Office for National Statistics. Baseline demographic data, lifestyle factors, gastrointestinal symptoms and quality of life were recorded at study entry. The effect of all these factors on persistent and new-onset GERS, and 10-year mortality, were examined using univariate and multivariate analysis, with results expressed as odds ratios (ORs) or hazard ratios (HR) with 99% confidence intervals (CI).
Results Of 3967 individuals providing complete GERS data at baseline and 10 years, 549 (13.8%) had GERS at baseline. Of these, 183 (33.3%) had persistent symptoms. Among 3418 individuals asymptomatic at baseline, approximately 0.8% per year developed new-onset GERS. No predictors of persistent GERS were identified. New-onset symptoms were associated with lower quality of life or presence of irritable bowel syndrome (IBS) at baseline, and higher body mass index (BMI) at 10 years. There were 8331 (99.1%) of 8407 subjects providing complete GERS data at baseline, 1289 (15.5%) of whom were symptomatic. Presence of GERS at baseline did not affect survival (HR: 0.84; 99% CI: 0.44–1.59).
Conclusions Gastro-oesophageal reflux symptoms persisted in one-third of individuals, whilst new-onset gastro-oesophageal reflux symptoms were associated with poor quality of life, irritable bowel syndrome and higher body mass index. Gastro-oesophageal reflux symptoms did not impact adversely on survival.
Typical symptoms of gastro-oesophageal reflux, such as heartburn and regurgitation, are common in the community. The prevalence of gastro-oesophageal reflux symptoms (GERS) in individual cross-sectional surveys varies from 2.5% to more than 20%, depending upon the criteria used to define their presence, and the geographical location of the study, with a lower prevalence of such symptoms in Asia.
Gastro-oesophageal reflux symptoms, like other chronic gastrointestinal (GI) symptoms, impact adversely on quality of life, and therefore lead to considerable morbidity. However, unlike most other chronic GI symptoms, their persistent nature may have more significant effects in the longer term. In one population-based endoscopic study, erosive oesophagitis was present in up to one-quarter of individuals reporting GERS, and presence of erosive oesophagitis at baseline was independently associated with subsequent development of Barrett's oesophagus 5 years later. Given that Barrett's oesophagus is the precursor of oesophageal adenocarcinoma, GERS may therefore play a role in its development. This is supported by a case–control study from Sweden, which demonstrated a strong association between frequent GERS and oesophageal adenocarcinoma.
Despite the potentially causal association between GERS and oesophageal adenocarcinoma, there are few data concerning the impact of GERS on mortality. In addition, despite the numerous cross-sectional surveys reporting the prevalence of GERS, there are only a small number of studies that have examined their long-term natural history in the community, including factors that predict the onset and resolution of symptoms.
We have an opportunity to address this in a large number of individuals selected randomly from the community and followed up over 10 years. We have reported data concerning the natural history of dyspepsia and irritable bowel syndrome (IBS) over the 10-year follow-up period in these individuals previously, as well as factors influencing consultation behaviour with either condition, and their impact on survival. We now report the long-term natural history of GERS and its effect on survival at 10 years.
Abstract and Introduction
Abstract
Background Gastro-oesophageal reflux symptoms (GERS) are common in the community. However, few studies have examined their long-term natural history, or impact on survival.
Aim To examine these issues in individuals recruited into a community-based screening programme for Helicobacter pylori in 1994.
Methods Data on mortality and cause of death at 10 years were obtained from the Office for National Statistics. Baseline demographic data, lifestyle factors, gastrointestinal symptoms and quality of life were recorded at study entry. The effect of all these factors on persistent and new-onset GERS, and 10-year mortality, were examined using univariate and multivariate analysis, with results expressed as odds ratios (ORs) or hazard ratios (HR) with 99% confidence intervals (CI).
Results Of 3967 individuals providing complete GERS data at baseline and 10 years, 549 (13.8%) had GERS at baseline. Of these, 183 (33.3%) had persistent symptoms. Among 3418 individuals asymptomatic at baseline, approximately 0.8% per year developed new-onset GERS. No predictors of persistent GERS were identified. New-onset symptoms were associated with lower quality of life or presence of irritable bowel syndrome (IBS) at baseline, and higher body mass index (BMI) at 10 years. There were 8331 (99.1%) of 8407 subjects providing complete GERS data at baseline, 1289 (15.5%) of whom were symptomatic. Presence of GERS at baseline did not affect survival (HR: 0.84; 99% CI: 0.44–1.59).
Conclusions Gastro-oesophageal reflux symptoms persisted in one-third of individuals, whilst new-onset gastro-oesophageal reflux symptoms were associated with poor quality of life, irritable bowel syndrome and higher body mass index. Gastro-oesophageal reflux symptoms did not impact adversely on survival.
Introduction
Typical symptoms of gastro-oesophageal reflux, such as heartburn and regurgitation, are common in the community. The prevalence of gastro-oesophageal reflux symptoms (GERS) in individual cross-sectional surveys varies from 2.5% to more than 20%, depending upon the criteria used to define their presence, and the geographical location of the study, with a lower prevalence of such symptoms in Asia.
Gastro-oesophageal reflux symptoms, like other chronic gastrointestinal (GI) symptoms, impact adversely on quality of life, and therefore lead to considerable morbidity. However, unlike most other chronic GI symptoms, their persistent nature may have more significant effects in the longer term. In one population-based endoscopic study, erosive oesophagitis was present in up to one-quarter of individuals reporting GERS, and presence of erosive oesophagitis at baseline was independently associated with subsequent development of Barrett's oesophagus 5 years later. Given that Barrett's oesophagus is the precursor of oesophageal adenocarcinoma, GERS may therefore play a role in its development. This is supported by a case–control study from Sweden, which demonstrated a strong association between frequent GERS and oesophageal adenocarcinoma.
Despite the potentially causal association between GERS and oesophageal adenocarcinoma, there are few data concerning the impact of GERS on mortality. In addition, despite the numerous cross-sectional surveys reporting the prevalence of GERS, there are only a small number of studies that have examined their long-term natural history in the community, including factors that predict the onset and resolution of symptoms.
We have an opportunity to address this in a large number of individuals selected randomly from the community and followed up over 10 years. We have reported data concerning the natural history of dyspepsia and irritable bowel syndrome (IBS) over the 10-year follow-up period in these individuals previously, as well as factors influencing consultation behaviour with either condition, and their impact on survival. We now report the long-term natural history of GERS and its effect on survival at 10 years.
