Hormone replacement therapy is associated with gastro-oesophageal reflux disease: a retrospective cohort study.
BACKGROUND
Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). Results of observational studies in women taking HRT rely on self-reporting of gastro-oesophageal symptoms and the aetiology of gastro-oesophageal reflux disease (GORD) remains unclear. This study investigated the association between HRT and GORD in menopausal women using validated general practice records.


METHODS
51,182 menopausal women were identified using the UK General Practice Research Database between 1995-2004. Of these, 8,831 were matched with and without hormone use. Odds ratios (ORs) were calculated for GORD and proton-pump inhibitor (PPI) use in hormone and non-hormone users, adjusting for age, co-morbidities, and co-pharmacy.


RESULTS
In unadjusted analysis, all forms of hormone use (oestrogen-only, tibolone, combined HRT and progestogen) were statistically significantly associated with GORD. In adjusted models, this association remained statistically significant for oestrogen-only treatment (OR 1.49; 1.18-1.89). Unadjusted analysis showed a statistically significant association between PPI use and oestrogen-only and combined HRT treatment. When adjusted for covariates, oestrogen-only treatment was significant (OR 1.34; 95% CI 1.03-1.74). Findings from the adjusted model demonstrated the greater use of PPI by progestogen users (OR 1.50; 1.01-2.22).


CONCLUSIONS
This first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance.
Durham Clinical Trials Unit, Queen's Campus, Wolfson Research Institute, University of Durham, University Boulevard, Stockton-on-Tees, TS17 6BH, UK. h.j.close@durham.ac.uk
Helen
H
Close
James M
JM
Mason
Douglas
D
Wilson
A Pali S
AP
Hungin
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004967:Estrogens / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology*; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011372:Progestins / Q000009:adverse effects*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom
D004967:Estrogens; D011372:Progestins; D054328:Proton Pump Inhibitors