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Summary Background : Cross‐sectional studies indicate that gastro‐oesophageal reflux disease symptoms have a prevalence of 10–20% in Western countries and are associated with obesity, smoking, oesophagitis, chest pain and respiratory disease. Aim : To determine the natural history of gastro‐oesophageal reflux disease presenting in primary care in the UK. Methods : Patients with a first diagnosis of gastro‐oesophageal reflux disease during 1996 were identified in the UK General Practice Research Database and compared with age‐ and sex‐matched controls. We investigated the incidence of gastro‐oesophageal reflux disease, potential risk factors and comorbidities, and relative risk for subsequent oesophageal complications and mortality. Results : The incidence of a gastro‐oesophageal reflux disease diagnosis was 4.5 per 1000 person‐years (95% confidence interval: 4.4–4.7). Prior use of non‐steroidal anti‐inflammatory drugs, smoking, excess body weight and gastrointestinal and cardiac conditions were associated with an increased risk of gastro‐oesophageal reflux disease diagnosis. Subjects with gastro‐oesophageal reflux disease had an increased risk of respiratory problems, chest pain and angina in the year after diagnosis, and had a relative risk of 11.5 (95% confidence interval: 5.9–22.3) of being diagnosed with an oesophageal complication. There was an increase in mortality in the gastro‐oesophageal reflux disease cohort only in the year following the diagnosis. Conclusions : Gastro‐oesophageal reflux disease is a disease associated with a range of potentially serious oesophageal complications and extra‐oesophageal diseases.

The prevalence and incidence of type 2 diabetes have increased in the UK over the past decade. This might be primarily explained by the changes in obesity prevalence. Also, there was a change in drug treatment pattern from sulphonylureas to metformin.

SUMMARYBackground: The aetiology of inflammatory bowel disease remains largely unknown. Aim: We performed a comprehensive assessment of potential risk factors associated with the occurrence of inflammatory bowel disease. Methods: We identified a cohort of patients 20-84 years old between 1995 and 1997 registered in the General Practitioner Research Database in the UK. A total of 444 incident cases of IBD were ascertained and validated with the general practitioner. We performed a nested case-control analysis using all cases and a random sample of 10 000 frequency-matched controls. Results: Incidence rates for ulcerative colitis, Crohn's disease, and indeterminate colitis were 11, 8, and 2

Smoking was identified as the only significant lifestyle-related risk factor for RA. Infection in the previous year was associated with a reduced likelihood of RA.

SUMMARY BackgroundThe roles of depression and antidepressants in triggering reflux symptoms remain unclear.

Summary Background : A link between gastro‐oesophageal reflux disease and coronary heart disease has been suggested. Aim : To estimate the incidence of myocardial infarction in patients with newly diagnosed gastro‐oesophageal reflux disease in comparison with that in the general population. Methods : A population‐based cohort study was performed in the UK. Patients aged 18–79 years with a first diagnosis of gastro‐oesophageal reflux disease (n = 7084) were identified and a group of 10 000 patients free of gastro‐oesophageal reflux disease were sampled. A nested case–control analysis was performed to assess the risk factors for myocardial infarction. Results : The incidence of myocardial infarction in the general population was 4.0 per 1000 person‐years [95% confidence interval (CI), 3.2–4.9] and 5.1 per 1000 person‐years (95% CI, 4.1–6.4) in patients with gastro‐oesophageal reflux disease. The relative risk of myocardial infarction in patients with gastro‐oesophageal reflux disease was 1.4 (95% CI, 1.0–1.9). The increased risk of myocardial infarction was limited to the immediate days after the diagnosis of gastro‐oesophageal reflux disease. Previous chest pain was an important predictor of myocardial infarction in patients free of gastro‐oesophageal reflux disease. No association was found between the use of acid‐suppressing drugs and the risk of myocardial infarction. Conclusion : Our results suggest that gastro‐oesophageal reflux disease is not an independent predictor of myocardial infarction. Rather, the increased risk of myocardial infarction in patients with gastro‐oesophageal reflux disease in the immediate days after diagnosis indicates that prodromal ischaemic symptoms were misinterpreted as reflux symptoms.

Study objective-The authors investigated whether patients who have survived an acute episode of peptic ulcer bleeding (PUB) have an excess long term all cause mortality compared with the general population free of PUB. Design-Follow up study of previously identified cohort of patients with a PUB episode and a general population cohort. Setting-The source population included all people aged 30 to 89 years, registered with general practitioners in the United Kingdom. Patients-All patients alive one month after the PUB episode constituted the cohort of PUB patients (n=978). A control group of 5000 people was randomly sampled from the source population. The same eligibility criteria as for patients with PUB were applied to the control series. Also, controls had to be free of PUB before start date. Main results-Relative risk of mortality among PUB patients was 2.1, 95%CI: 1.7, 2.6) compared with the general population. This increased mortality risk occurred mainly in the patients less than 60 years old. No diVerence was observed between men and women. The excess mortality was not only circumscribed to deaths attributable to recurrent gastrointestinal bleed, but also cardiovascular, cancer and other causes. Conclusions-People who have survived an acute episode of PUB have a reduced long term survival compared with the general population.This reduction was stronger among middle age patients than in the elderly.