title: Lifestyle factors affecting gastroesophageal reflux disease symptoms: a cross-sectional study of healthy 19864 adults using FSSG scores.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a very common disorder worldwide, comprised of reflux esophagitis (RE) and non-erosive reflux disease (NERD). As more than half of GERD patients are classified into the NERD group, precise evaluation of bothersome epigastric symptoms is essential. Nevertheless, compared with many reports targeting endoscopic reflux esophagitis, large-scale studies focusing on GERD symptoms have been very scarce.
  
  
  METHODS
  To elucidate lifestyle factors affecting GERD symptoms, 19,864 healthy adults in Japan were analyzed. Sub-analyses of 371 proton pump inhibitor (PPI) users and 539 histamine H₂-receptor antagonist (H₂RA) users were also performed. Using the FSSG (Frequency Scale for the Symptoms of GERD) score as a response variable, 25 lifestyle-related factors were univariately evaluated by Student's t-test or Pearson's correlation coefficient, and were further analyzed with multiple linear regression modelling.
  
  
  RESULTS
  Average FSSG scores were 4.8 ± 5.2 for total subjects, 9.0 ± 7.3 for PPI users, and 8.2 ± 6.6 for H₂RA users. Among the total population, positively correlated factors and standardized coefficients (β) for FSSG scores are inadequate sleep (β = 0.158), digestive drug users (β = 0.0972 for PPI, β = 0.0903 for H₂RA, and β = 0.104 for others), increased body weight in adulthood (β = 0.081), dinner just before bedtime (β = 0.061), the habit of midnight snack (β = 0.055), lower body mass index (β = 0.054), NSAID users (β = 0.051), female gender (β = 0.048), lack of breakfast (β = 0.045), lack of physical exercise (β = 0.035), younger age (β = 0.033), antihyperglycemic agents non-users (β = 0.026), the habit of quick eating (β = 0.025), alcohol drinking (β = 0.025), history of gastrectomy (β = 0.024), history of cardiovascular disease (β = 0.020), and smoking (β = 0.018). Positively correlated factors for PPI users are female gender (β = 0.198), inadequate sleep (β = 0.150), lack of breakfast (β = 0.146), antihypertensive agent non-users (β = 0.134), and dinner just before bedtime (β = 0.129), whereas those for H₂RA users are inadequate sleep (β = 0.248), habit of midnight snack (β = 0.160), anticoagulants non-users (β = 0.106), and antihypertensive agents non-users (β = 0.095).
  
  
  CONCLUSIONS
  Among many lifestyle-related factors correlated with GERD symptoms, poor quality of sleep and irregular dietary habits are strong risk factors for high FSSG scores. At present, usual dose of PPI or H₂RA in Japan cannot fully relieve GERD symptoms.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. nyamamic-tky@umin.ac.jp
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.forename: Itsuko
authors.initials: I
authors.lastname: Asada-Hirayama
authors.forename: Rie
authors.initials: R
authors.lastname: Mikami-Matsuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamoto
authors.forename: Maki
authors.initials: M
authors.lastname: Konno-Shimizu
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Chihiro
authors.initials: C
authors.lastname: Takeuchi
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.forename: Chihiro
authors.initials: C
authors.lastname: Minatsuki
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Toru
authors.initials: T
authors.lastname: Mitsushima
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012893:Sleep Wake Disorders / Q000150:complications
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors