title: Do differences in female sex hormone levels contribute to gastro-oesophageal reflux disease?
abstract: BACKGROUND
  Hormone replacement therapy is associated with both reflux symptoms and oesophagitis. During pregnancy, elevated sex hormones are thought to contribute to the high prevalence of reflux symptoms. Increased female sex hormone levels may thus contribute to the aetiology of gastro-oesophageal reflux disease (GORD).
  
  
  OBJECTIVE
  To determine if female sex hormone levels are associated with symptomatic acid reflux.
  
  
  METHODS
  Women with GORD symptoms undergoing oesophageal pH monitoring were prospectively recruited. 'Cases' and 'controls' were defined by normal and excess total acid exposure on pH monitoring and were age-matched and BMI-matched. Case and control groups were further stratified into premenopausal and postmenopausal groups. Demographic data were collected, body morphological parameters were measured and oestradiol, oestrone, progesterone and sex hormone-binding globulin were measured.
  
  
  RESULTS
  One hundred and twenty-one women [mean age 52 (SD 11.6) years] were recruited and 104 [mean age 51 (SD 11.6) years] were matched for age and BMI. Increasing BMI, as expected, correlated with increasing acid exposure [premenopausal (r=0.404, P=0.02), postmenopausal (r=0.401, P=0.01)]. Increasing BMI also correlated with sex hormone levels [premenopausal oestradiol (r=0.52, P=0.004), postmenopausal oestrone (r=0.364, P=0.01)]. In premenopausal women, sex hormone binding globulin (r=-0.27, P=0.05) and testosterone (r=0.29, P=0.05) correlated with increasing acid exposure, but oestradiol fell just short of significance (r=0.26, P=0.06). However, on matching for BMI, no association between sex hormones and increased acid exposure on pH monitoring was found on multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  Female sex hormone levels do not appear to contribute to GORD, once adjustment is made for the influence of increasing BMI.
authors.affiliation: Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, UK. shyam.menon@nhs.net
authors.forename: Shyam
authors.initials: S
authors.lastname: Menon
authors.forename: Sandra
authors.initials: S
authors.lastname: Prew
authors.forename: Gill
authors.initials: G
authors.lastname: Parkes
authors.forename: Stephanie
authors.initials: S
authors.lastname: Evans
authors.forename: Lynne
authors.initials: L
authors.lastname: Smith
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Nigel
authors.initials: N
authors.lastname: Trudgill
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D050782:Esophageal pH Monitoring; D004958:Estradiol / Q000097:blood; D004970:Estrone / Q000097:blood; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood* / Q000175:diagnosis; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017698:Postmenopause / Q000097:blood; D017697:Premenopause / Q000097:blood; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D012739:Gonadal Steroid Hormones; D012738:Sex Hormone-Binding Globulin; D004970:Estrone; D011374:Progesterone; D004958:Estradiol