Postmenopausal hormone use and symptoms of gastroesophageal reflux.
BACKGROUND
Previous studies suggest that elevated levels of estrogen and progesterone, either through endogenous or exogenous sources, increase gastroesophageal reflux.


METHODS
To evaluate the relationship between symptoms of gastroesophageal reflux disease (GERD) and postmenopausal hormone (PMH) therapy, including the use of selective estrogen receptor modulators and over-the-counter (OTC) hormone preparations, we performed a prospective cohort study of 51,637 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of PMH therapy biennially since 1976, and information about symptoms of GERD in 2002.


RESULTS
Among eligible participants, 12 018 women (23%) reported GERD symptoms. Compared with women who never used PMHs, the multivariate odds ratio (OR) for the risk of GERD symptoms was 1.46 (95% confidence interval [CI], 1.36-1.56) for past hormone users, 1.66 (95% CI, 1.54-1.79) for current users of estrogen only, and 1.41 (95% CI, 1.29-1.54) for current users of combined estrogen and progesterone. The risk of GERD symptoms increased significantly with increasing estrogen dosage (P < .001) and increasing duration of estrogen use (P < .001). Moreover, current selective estrogen receptor modulator users experienced an OR of 1.39 (95% CI, 1.22-1.59) for GERD symptoms, and women currently using OTC hormone preparations had an OR of 1.37 (95% CI, 1.16-1.62).


CONCLUSIONS
Postmenopausal use of estrogens, selective estrogen receptor modulators, or OTC hormone preparations is associated with a greater likelihood of symptoms of GERD. This suggests a hormonal component to the pathophysiologic characteristics of GERD in women.
Jacobson
Brian C
BC
Section of Gastroenterology, Boston Medical Center, and School of Medicine, Boston University, 88 E Concord St, Room 7721, Boston, Massachusetts 02118, USA. brian.jacobson@bmc.org
Moy
Beverly
B
Colditz
Graham A
GA
Fuchs
Charles S
CS
D000328:Adult; D015992:Body Mass Index; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000139:chemically induced* / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects*
D004967:Estrogens; D004366:Nonprescription Drugs; D020845:Selective Estrogen Receptor Modulators
Gastroenterology. 1977 Apr;72(4 Pt 1):666-8
14050
Lancet. 1990 Jan 27;335(8683):205-8
1967675
N Engl J Med. 2006 Jul 13;355(2):125-37
16837676
Gastroenterology. 1977 Nov;73(5):1082-5
908487
Gastroenterology. 2002 May;122(5):1500-11
11984534
Arch Intern Med. 2006 Jul 24;166(14):1453-65
16864755
Gastroenterology. 1997 May;112(5):1448-56
9136821
Ann Intern Med. 1998 Feb 15;128(4):285-8
9471931
N Engl J Med. 1999 Mar 18;340(11):825-31
10080844
N Engl J Med. 2006 Jun 1;354(22):2340-8
16738270
Am J Epidemiol. 1985 Jul;122(1):51-65
4014201
Gastroenterology. 1998 Dec;115(6):1374-80
9834264
Am J Gastroenterol. 2005 Jun;100(6):1243-50
15929752
Gastroenterology. 1976 Aug;71(2):232-4
939383
Mayo Clin Proc. 1994 Jun;69(6):539-47
8189759
N Engl J Med. 1982 Dec 16;307(25):1547-52
7144836
Int J Epidemiol. 1994 Oct;23(5):991-9
7860180
J Clin Invest. 1980 Feb;65(2):256-67
7356677
Scand J Gastroenterol. 2002 Jun;37(6):626-30
12126237
Gastroenterology. 2004 Mar;126(3):660-4
14988819
Ann Intern Med. 2002 Nov 19;137(10):805-13
12435217
Epidemiology. 1990 Nov;1(6):466-73
2090285
N Engl J Med. 2003 Feb 13;348(7):618-29
12584371
Gastroenterology. 2004 Jun;126(7):1692-9
15188164
J Clin Endocrinol Metab. 2003 Sep;88(9):4348-54
12970309
N Engl J Med. 1997 Mar 27;336(13):924-32
9070474
Am J Physiol. 1978 Mar;234(3):E243-7
629338
Gastroenterology. 1978 Jun;74(6):1233-7
648814
Am J Med. 1999 Jun;106(6):642-9
10378622
JAMA. 2003 Jul 2;290(1):66-72
12837713