Determinants of Gastroesophageal Reflux Disease, Including Hookah Smoking and Opium Use– A Cross-Sectional Analysis of 50,000 Individuals

Abstract

BackgroundGastroesophageal reflux disease (GERD) is a common cause of discomfort and morbidity worldwide. However, information on determinants of GERD from large-scale studies in low- to medium-income countries is limited. We investigated the factors associated with different measures of GERD symptoms, including frequency, patient-perceived severity, and onset time.MethodsWe performed a cross-sectional analysis of the baseline data from a population-based cohort study of ∼50,000 individuals in in Golestan Province, Iran. GERD symptoms in this study included regurgitation and/or heartburn.ResultsApproximately 20% of participants reported at least weekly symptoms. Daily symptoms were less commonly reported by men, those of Turkmen ethnicity, and nass chewers. On the other hand, age, body mass index, alcohol drinking, cigarette smoking, opium use, lower socioeconomic status, and lower physical activity were associated with daily symptoms. Most of these factors showed similar associations with severe symptoms. Women with higher BMI and waist to hip ratio were more likely to report frequent and severe GERD symptoms. Hookah smoking (OR 1.34, 95% CI 1.02–1.75) and opium use (OR 1.70, 95% CI 1.55–1.87) were associated with severe symptoms, whereas nass chewing had an inverse association (OR 0.87, 95% CI 0.76–0.99). After exclusion of cigarette smokers, hookah smoking was still positively associated and nass chewing was inversely associated with GERD symptoms (all frequencies combined).ConclusionGERD is common in this population. The associations of hookah and opium use and inverse association of nass use with GERD symptoms are reported for the first time. Further studies are required to investigate the nature of these associations. Other determinants of GERD were mostly comparable to those reported elsewhere.

Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis

“…From these we identified 365 that appeared to be relevant to the study question. There were 102 articles that fulfilled the eligibility criteria,11 19–119 representing 108 separate adult study populations, containing 460 984 subjects (see online supplementary figure S1). There were a further 12 papers that reported data concerning the prevalence of gastro-oesophageal reflux symptoms according to use of alcohol, smoking status, gender and age from one of these 108 separate study populations,120–131 which were not published in the primary article arising from that study, meaning that we extracted data from 114 separate articles in total.…”

“…The majority of studies used accepted diagnostic criteria to define the presence of gastro-oesophageal reflux symptoms, with 26 using more than one set of criteria within the same population 11 29 31 36 42 46 51–54 59 64–66 72 75 83 87 88 91 92 95 96 102 108 119. Details of symptom frequency and duration required to meet criteria for gastro-oesophageal reflux symptoms in each study are provided in online supplementary table S1.…”

“…Details of symptom frequency and duration required to meet criteria for gastro-oesophageal reflux symptoms in each study are provided in online supplementary table S1. In total, 79 studies (reporting 85 separate study populations) used a frequency of the presence of heart burn and/or regurgitation of at least once a week to define gastro-oesophageal reflux symptoms,11 22 25 27–29 32–34 36 38 40 41 44 45–48 50–61 64–77 79–89 91–97 99–101 102 104 105 107–109 111–117 119 two studies used the Rome II criteria42 98 and two the Rome I criteria 23 62…”

“…Subgroup analyses were conducted according to geographical region, criteria used to define gastro-oesophageal reflux symptoms, duration used to define presence of gastro-oesophageal reflux symptoms and method used to collect symptom data. The prevalence of gastro-oesophageal reflux symptoms was compared according to proposed risk factors, which were chosen a priori, and included age,14 gender,14 current smoking status,15 self-reported use or non-use of alcohol,15 self-reported use or non-use of non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin,16 presence or absence of obesity,15 socioeconomic status,11 and educational level,17 using an OR, with a 95% CI.…”

“…Gastro-oesophageal reflux symptoms are prevalent, seen both in primary and secondary care settings 11. There have been numerous cross-sectional surveys conducted that report the prevalence of symptoms of gastro-oesophageal reflux in the community.…”