GERD Not a Killer Disease

By Charles Bankhead
ROCHESTER, Minn., Jan. 4 -- Gastroesophageal reflux disease does not confer excess mortality, according to large observational study here.In fact, patients with intermittent or infrequent GERD symptoms had better survival than patients with no history of GERD or frequent episodes, Nicholas J. Talley, M.D., Ph.D., of the Mayo Clinic, and colleagues reported in the January issue of the American Journal of Gastroenterology.
"Patients who have symptomatic reflux disease should not be overly concerned about this disease affecting their longevity, and physicians should bear these data in mind when deciding whether or not to consider esophagogastroduodenoscopy to screen otherwise healthy patients with symptomatic reflux for esophageal adenocarcinoma," the authors concluded.
Several studies have demonstrated an association between GERD and esophageal adenocarcinoma. In one study, patients with severe and long-term reflux symptoms had odds ratio for esophageal cancer of 43.5.
The association with cancer has led to concern that GERD might reduce survival, the authors noted. However, few studies had examined associations between reflux and survival, and those studies yielded inconsistent results.
Dr. Talley and colleagues examined data from symptom surveys mailed to population-based cohorts from 1988 through 1993. Respondents were separated into four GERD symptom categories: daily, at least weekly, infrequent (less than weekly), and none. Administrative records for respondents were used to identify deaths during follow-up through June 2006.
Of the 5,288 respondents (mean age 53) at baseline, 2% reported daily heartburn, 13% weekly, 40% infrequent, and 35% no heartburn. After 10 years of follow-up, 83% of patients reporting no heartburn were still alive. Compared with the no-heartburn group, patients with daily heartburn had a nonsignificant 16% increase in the hazard for death.
In contrast, patients reporting weekly or infrequent heartburn had significantly better 10-year survival compared with patients reporting no heartburn at baseline. Weekly heartburn was associated with a 33% improvement in survival (hazard ratio: 0.67, 95% CI: 0.55 to 0.83), and individuals initially reporting infrequent GERD symptoms had a 20% improvement in survival (HR: 0.80, 95% CI: 0.70 to 0.92).
Older age, male sex, higher Charlson index, and tobacco use all predicted worse survival.
"The vast majority of heartburn sufferers can be reassured of the benign nature of their condition," the authors concluded.
As for the improved survival observed in patients with occasional reflux, the authors said, "it may be that occasional reflux symptoms are a reflection of potential protective behaviors that are associated with reflux, such as regular exercise or modest amounts of alcohol ingestion."
The authors pointed out that, "while the data may be applicable to predominantly white populations like Olmsted County, the data may not be generalizable to other ethnic groups."
Dr. Talley reported receiving research and grant support from Tap Pharmaceuticals and GlaxoSmithKline.
Primary source: American Journal of GastroenterologySource reference:Talley NJ, et al "Impact of gastroesophageal reflux on survival in the community" Am J Gastroenterol 2008; 103: 12-19.