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      Long-Term Benefits of Smoking Cessation on Gastroesophageal Reflux Disease and Health-Related Quality of Life

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          Abstract

          Objective

          Smoking is associated with gastroesophageal reflux disease (GERD). Varenicline, a nicotinic receptor partial agonist, is used to aid smoking cessation. The purpose of this study was to prospectively examine the long-term benefits of smoking cessation on GERD and health-related quality of life (HR-QOL).

          Methods

          Patients treated with varenicline were asked to fill out a self-report questionnaire about their smoking habits, gastrointestinal symptoms, and HR-QOL before and 1 year after smoking cessation. The prevalence of GERD, frequency of symptoms, and HR-QOL scores were compared. We also investigated associations between clinical factors and newly-developed GERD.

          Results

          A total of 141 patients achieved smoking cessation (success group) and 50 did not (failure group) at 1 year after the treatment. The GERD improvement in the success group (43.9%) was significantly higher than that in the failure group (18.2%). The frequency of reflux symptoms significantly decreased only in the success group. There were no significant associations between newly developed GERD and clinical factors including increased body mass index and successful smoking cessation. HR-QOL significantly improved only in the success group.

          Conclusions

          Smoking cessation improved both GERD and HR-QOL. Smoking cessation should be recommended for GERD patients.

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          Most cited references22

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          Development and evaluation of FSSG: frequency scale for the symptoms of GERD.

          TADASHI SUGIYAMA, Masatomo Mori, T Higuchi … (2004)
          The aim of this study was to produce a simplified questionnaire for evaluation of the symptoms of gastroesophageal reflux disease (GERD). A total of 124 patients with an endoscopic diagnosis of GERD completed a 50-part questionnaire, requiring only "yes" or "no" answers, that covered various symptoms related to the upper gastrointestinal tract, as well as psychosomatic symptoms. The 12 questions to which patients most often answered "yes" were selected, and were assigned scores (never = 0; occasionally = 1; sometimes = 2; often = 3; and always = 4) to produce a frequency scale for symptoms of GERD (FSSG). Sensitivity, specificity, and accuracy of the FSSG questionnaire were evaluated in another group of patients with GERD and non-GERD. The usefulness of this questionnaire was evaluated in 26 other GERD patients who were treated with proton pump inhibitors for 8 weeks. When the cutoff score was set at 8 points, the FSSG showed a sensitivity of 62%, a specificity of 59%, and an accuracy of 60%, whereas a cutoff score of 10 points altered these values to 55%, 69%, and 63%. The score obtained using the questionnaire correlated well with the extent of endoscopic improvement in patients with mild or severe GERD. This new questionnaire is useful for the objective evaluation of symptoms in GERD patients.
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            Epidemiology and clinical characteristics of GERD in the Japanese population.

            Tetsuo Arakawa, Yasuhiro Fujiwara (2008)
            We reviewed articles on the epidemiology and clinical characteristics of gastroesophageal reflux disease (GERD) in Japan to clarify these features of GERD in this country. Although the definition of GERD depends on the individual study, the prevalence of GERD has been increasing since the end of the 1990s. The reasons for the increase in the prevalence of GERD may be due to increases in gastric acid secretion, a decrease in the Helicobacter pylori infection rate, more attention being paid to GERD, and advances in the concept of GERD. More than half of GERD patients had non-erosive reflux disease, and the majority (87%) of erosive esophagitis was mild type, such as Los Angeles classification grade A and grade B. There were several identified risk factors, such as older age, obesity, and hiatal hernia. In particular, mild gastric atrophy and absence of H. pylori infection influence the characteristics of GERD in the Japanese population. We also discuss GERD in the elderly; asymptomatic GERD; the natural history of GERD; and associations between GERD and peptic ulcer disease and H. pylori eradication. We examined the prevalence of GERD in patients with specific diseases, and found a higher prevalence of GERD, compared with that in the general population, in patients with diabetes mellitus, those with obstructive sleep apnea syndrome, and those with bronchial asthma. We provide a comprehensive review of GERD in the Japanese population and raise several clinical issues.
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              Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach.

              Tonya Kaltenbach, Seth Crockett, Lauren Gerson (2006)
              Lifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.
              Article 0 comments Cited 94 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ken-ichi Mukaisho: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 4 February 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 2
                Electronic Location Identifier: e0147860
                Affiliations
                [1 ]Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
                [2 ]Uehonmachi-Watanabe Clinic, Osaka, Japan
                [3 ]Department of Medical Education and General Practice, Osaka City University Graduate School of Medicine, Osaka, Japan
                Shiga University of Medical science, JAPAN
                Author notes

                Competing Interests: Prof. Arakawa received lecture fees from Otsuka and Eisai and research grants from Otsuka, Eisai, Astellas, Abbott Japan, Takeda, Dainippon Sumitomo, and Daiichi Sankyo. The remaining authors have no conflicts to disclose. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: YK YF. Performed the experiments: YK Takanori Watanabe MK YT. Analyzed the data: YK MS. Wrote the paper: YK YF Takanori Watanabe MK YT NK HY TT MS Toshio Watanabe KT TS TA.

                Article
                Publisher ID: PONE-D-15-45120
                DOI: 10.1371/journal.pone.0147860
                PMC ID: 4742243
                PubMed ID: 26845761
                SO-VID: 83eba423-2201-47d7-b652-bc844f72e71c
                Copyright © © 2016 Kohata et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 15 October 2015
                Date accepted : 8 January 2016
                Page count
                Figures: 5, Tables: 2, Pages: 12
                Funding
                The authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Behavior
                Subject: Habits
                Subject: Smoking Habits
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Biology and Life Sciences
                Subject: Nutrition
                Subject: Diet
                Subject: Alcohol Consumption
                Subject: Medicine and Health Sciences
                Subject: Nutrition
                Subject: Diet
                Subject: Alcohol Consumption
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Biology and Life Sciences
                Subject: Behavior
                Subject: Habits
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Questionnaires
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Surveys
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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