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Gastroesophageal reflux disease and heartburn - Risk Factors

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of GERD.

Alternative Names

Heartburn; GERD

Risk Factors:

GERD occurs monthly in about half of American adults. People of all ages are susceptible to GERD. Elderly people with GERD tend to have a more serious condition than younger people.

Risk Factors for Heartburn and GERD

Eating Pattern. Anyone who eats a heavy meal and then lies on their back or bends over from the waist is at risk for an attack of heartburn. Anyone who snacks at bedtime is also at high risk for heartburn.

Pregnancy. Pregnant women are particularly vulnerable to GERD in their third trimester, as the growing uterus puts increasing pressure on the stomach. Heartburn in such cases is often resistant to dietary interventions and even to antacids.

Obesity. A number of studies suggest that obesity contributes to GERD, and it may increase the risk for erosive esophagitis (severe inflammation in the esophagus) in GERD patients. Having a large amount of fat in the abdomen may be the most important risk factor for the development of acid reflux and associated complications such as Barrett's esophagus and cancer of the esophagus, studies indicate. Researchers have also reported that increased BMI is associated with more severe GERD symptoms. Losing weight appears to help reduce GERD symptoms.

Respiratory Diseases. People with asthma are at very high risk for GERD. Between 50% and 90% of patients with asthma have some symptoms of GERD. People with chronic obstructive pulmonary diseases (such as emphysema or chronic bronchitis) may also be more likely to have GERD.

Chronic obstructive pulmonary disease (COPD) refers to chronic lung disorders that result in blocked air flow in the lungs. The two main COPD disorders are emphysema and chronic bronchitis, the most common causes of respiratory failure. Emphysema occurs when the walls between the lung's air sacs become weakened and the sacs get enlarged and filled with too much air. Damage from COPD is usually permanent and irreversible.

COPD (Chronic Obstructive Pulmonary Disorder)

Smoking. Increasing evidence indicates that smoking raises the risk for GERD. Studies suggest that smoking reduces LES muscle function, increases acid secretion, impairs muscle reflexes in the throat, and damages protective mucus membranes. Smoking reduces salivation, which helps neutralize acid. It is unknown whether the smoke, nicotine, or both trigger GERD. Some people who use nicotine patches to quit smoking, for example, have heartburn, but it is not clear whether the nicotine or stress produces the acid backup. In addition, smoking can lead to emphysema, which is itself a risk factor for GERD.

Alcohol Use. Alcohol has mixed effects on GERD. It relaxes the LES muscles and, in high amounts, may irritate the mucus membrane of the esophagus. Small amounts of alcohol, however, may actually protect the mucosal layer. A combination of heavy alcohol use and smoking increases the risk for esophageal cancer.

Hormone Replacement Therapy. Symptoms of GERD are more likely to occur in postmenopausal women who receive hormone replacement therapy. The risk increases with larger estrogen doses and longer duration of therapy.

Resources

http://digestive.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
www.gastro.org -- American Gastroenterological Association
www.acg.gi.org -- American College of Gastroenterology
www.asge.org -- American Society for Gastrointestinal Endoscopy
www.ssat.com -- Society for Surgery of the Alimentary Tract
www.naspgn.org -- North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
www.reflux.org -- Pediatric/Adolescent Gastroesophageal Reflux Association
www.iffgd.org -- International Foundation for Functional Gastrointestinal Disorders

References

Barbas AS, Downing TE, Balsara KR, Tan HE, Rubinstein GJ, Holzknecht ZE, et al. Chronic aspiration shifts the immune response from Th1 to Th2 in a murine model of asthma. Eur J Clin Invest. 2008;38:596-602.

Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend: Sabiston Textbook of Surgery, 18th ed. Philadelphia, PA:WB Saunders; 2007:chap 42.

Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg. 2007;246(1):11-21.

Francisco C, Ramirez FC, Akins R, et al. Screening of Barrett's esophagus with string-capsule endoscopy: a prospective blinded study of 100 consecutive patients using histology as the criterion standard. Gastrointestinal Endosc. 2008; 68(1):25-31.

Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111-2122.

Furnée EJ, Draaisma WA, Broeders IA, Smout AJ, Gooszen HG. Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients. Arch Surg. 2008;143:267-274.

Gee DW, ANdreoli MT, Rattner DW. Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch Surg. 2008;143:482-487.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.

Hirano I, Richter JE, and the Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. American Journal of Gastroenterology. 2007;102:668-685.

Jacobson BC, Moy B, Colditz GA, et al. Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux. Arch Intern Med. 2008;168(16):1798-1804.

Mishkin DS, Chuttani R, Croffie J, et al. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointestinal Endoscopy. 2008;63(4): 539-545.

Orenstein S, Peters J, Khan S, et al. Gastroesophageal Reflux Disease (GERD). In: Kliegman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA: WB Saunders; 2007:chap 320.

Talley NJ, Locke GR 3rd, McNally M, Schleck CD, Zinsmeister AR, Melton LJ 3rd. Impact of gastroesophageal reflux on survival in the community. Am J Gastroenterol. 2008;103:12-19.

Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Lesie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008;179:319-326.

Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med. 2008;149:391-398.

Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Wilson JF. In The Clinic: Gastroesophageal Reflux Disease. Ann Intern Med. 2008;149(3):ITC2-1-15.

Zhao Y, Encinosa W. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005. Agency for Healthcare Research and Quality, January 2008.

Reviewed last on: 10/12/2008
Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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