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Obesity and oestrogen – risk factors for GORD

Obesity is significantly associated with symptoms of gastro-oesophageal reflux (heartburn and regurgitation), especially in women who are premenopausal, according to the results of a study recently published in JAMA. In addition, hormone therapy strengthens the association, suggesting that oestrogens play an important role in the aetiology of gastro-oesophageal reflux disease (GORD).

The incidence of both GORD and obesity is rising rapidly in Western societies. GORD adversely impacts on quality of life, and the costs for medication to treat the condition are high. Although symptoms of GORD and obesity have already been established as risk factors for oesophageal adenocarcinoma, the relationship between obesity and reflux symptoms has not yet been clarified.

This large, population-based, cross-sectional, case-control study evaluated the relation between body mass and symptoms of GORD, and how this is influenced by female sex hormones. There was a strong and dose-dependent association between increased body mass and symptomatic reflux in women, and a moderate association among men. The association was stronger among premenopausal women.

Hormone therapy was a weak risk factor for reflux symptoms in women of normal weight, but the association between hormone therapy and reflux became progressively stronger with increasing body mass. This effect was more pronounced with oestrogen-only treatment. Importantly, the study demonstrated that weight reduction was associated with reduced risk of reflux symptoms.

Nilsson M, Johnsen R, Ye W, et al. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 2003;290:66-72.

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