title: Risk factors for nocturnal reflux in a large GERD cohort.
abstract: BACKGROUND
  Nocturnal gastroesophageal reflux disease (GERD) has been associated with severe complications including erosive esophagitis, peptic stricture, and even esophageal adenocarcinoma and is known to cause a decreased health-related quality of life. However, there is limited information on independent predictors of nocturnal GERD.
  
  
  OBJECTIVE
  The aim of this study was to examine the relationship between nocturnal GERD and patient demographics, symptoms, clinical and endoscopic findings.
  
  
  METHODS
  Consecutive patients presenting to the gastrointestinal endoscopy unit for evaluation of GERD symptoms undergoing index endoscopy were asked to complete a validated GERD questionnaire. Demographics, clinical features, and endoscopic findings were recorded. Nocturnal GERD was defined as awakening at night by heartburn or acid regurgitation. Patient factors were compared using χ and Mann-Whitney U test. All factors that were statistically significant (P<0.05) were entered into a stepwise logistic regression to evaluate for independent predictors of nocturnal GERD.
  
  
  RESULTS
  Of 908 GERD patients evaluated, 665 (73.2%) reported nocturnal symptoms. The majority of the patients were male (93%) and White (83%) with a mean age of 57.2 years (SD 12.7). On univariate analysis, younger age, higher body mass index, daily heartburn, heartburn duration of >5 years, severe heartburn, daily regurgitation, regurgitation duration >5 years (all P<0.05), and presence of hiatal hernia (P=0.02) were significantly associated with the presence of nocturnal GERD. On multivariate analysis, severe heartburn [3.3 (2.1 to 5.1), P<0.01] and daily heartburn [1.5(1.1 to 2.3), P=0.03], daily regurgitation [2.2 (1.1 to 4.2), P=0.025], and regurgitation duration of >5 years [1.7 (1.2 to 2.4), P<0.01], and presence of hiatal hernia [1.4 (1.1 to 2.0), P=0.03] were all independent risk factors for nocturnal GERD.
  
  
  CONCLUSIONS
  Results of this large prospective cohort study of GERD patients suggest that nocturnal symptoms are reported by 3 quarters of patients. Patients with frequent and severe daytime symptoms are significantly more likely to experience nocturnal symptoms. There was no significant difference in the prevalence of Barrett esophagus between patients with and without nocturnal GERD. Finally, presence of a hiatus hernia on endoscopy is also an independent risk factor for nocturnal GERD.
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO 64128-2295, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Haripriya
authors.initials: H
authors.lastname: Maddur
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Brian
authors.initials: B
authors.lastname: Moloney
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000503:physiopathology*; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors