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Impact of Gastroesophageal Reflux on Survival in the Community

Talley, Nicholas J., M.D., Ph.D.1,4; Richard Locke, G. III, M.D.1; McNally, M., M.D.1; Schleck, Cathy D., B.S.2; Zinsmeister, Alan R., Ph.D.2; Joseph Melton, L. III, M.D.3

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 12–19
ORIGINAL CONTRIBUTIONS: ESOPHAGUS
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BACKGROUND: Concerns have been raised regarding the risks associated with gastroesophageal reflux (GER). We examined the association of gastroesophageal reflux with survival.

METHODS Between 1988 and 1993, valid symptom surveys were mailed to population-based cohorts. Respondents were classified into 4 GER symptom categories: daily, at least weekly (not daily), infrequent (less than weekly), and none. Administrative records were used to identify deaths during the follow-up (through June 2006). Association between survival and GER subgroups was assessed using proportional hazards regression to compute hazard ratios (HRs, 95% confidence intervals), adjusting for age, gender, education level, Charlson Comorbidity Index, alcohol, and tobacco.

RESULTS At baseline, 5,288 eligible subjects (mean age 53 yr, 51% female) responded (response rates over 70%); 2% reported daily heartburn, 13% weekly (not daily) heartburn, 40% infrequent heartburn, and 35% no heartburn. At 10 yr, 83% (95% CI 81–84%) of the no heartburn group was alive. An overall association between heartburn category and survival was detected (P < 0.001). Compared to no heartburn, daily heartburn was not associated with an increased risk of death (HR 1.16, 95% CI 0.82–1.65), but better survival was observed for weekly (HR 0.67, 95% CI 0.55–0.83) and infrequent (HR 0.80, 95% CI 0.70–0.92) heartburn. Increasing age, male gender, greater Charlson index, and tobacco use all predicted worse survival.

CONCLUSIONS In this population-based study with over 50,000 person-years of follow-up, reflux symptoms were not associated with worse survival. The vast majority of heartburn sufferers can be reassured of the benign nature of their condition.

1Dyspepsia Center, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and Hepatology, 2Department of Health Sciences Research, Division of Biostatistics, 3Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota; and 4Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida

Reprint requests and correspondence: Nicholas J. Talley, M.D., Ph.D., Professor of Medicine and Epidemiology, Mayo Clinic College of Medicine, Chair, Department of Internal Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, Florida 32224.

Received May 8, 2007; accepted July 24, 2007.

CONFLICT OF INTERESTGuarantor of the article: Nicholas J. Talley, M.D., Ph.D.

Specific author contributions: Study design, review of data, manuscript revision – Nicholas J. Talley, G. Richard Locke, III, M. McNally, Alan R. Zinsmeister, and L. Joseph Melton, III. Manuscript preparation – Nicholas J. Talley. Statistical analysis – Alan R. Zinsmeister and Cathy D. Schleck.

Financial support: None.

Potential competing interests: Nicholas J. Talley: grant/research support: Tap Pharmaceuticals, GlaxoSmithKline. G. Richard Lock, III: grant/research support: AstraZeneca, GlaxoSmithKline, Janssen, TAP; consulting: Boehringer Ingelheim, GlaxoSmithKline, Novartis, Solvay, Takeda. Meredythe McNally: none to declare. Cathy D. Schleck: none to declare. Alan R. Zinsmeister: none to declare. L. Joseph Melton, III: none to declare.

© The American College of Gastroenterology 2008. All Rights Reserved.
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