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      Iranian lifestyle factors affecting reflux disease among healthy people in Qom

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          Abstract

          Background and aim

          Gastroesophageal reflux disease (GERD) is one of the most common digestive system disorders. Life style factors may increase the risk of reflux disease. We aimed to determine prevalence of reflux and related life style-factors in the population living in Qom.

          Methods

          This cross-sectional study was conducted among 1500 residents of Qom in 2014. Individuals were selected through multi-stage sampling. They completed two questionnaires: FSSG questionnaire for diagnosis of GERD and a general questionnaire to measure demographic and lifestyle factors. Univariate and multivariate were used for analysis of data. Data were analyzed using IBM SPSS version 20.

          Results

          A total of 1130 individuals were analyzed in which 52.4% of them were female. Prevalence of GERD was 28%. Adjusted findings showed use of PPIs (OR: 2.2, 95% CI: 2–5), taking H2RAs (OR: 4.7, 95% CI: 2.3–9.4), the habit of quick eating (OR: 1.5, 95% CI: 1.1–2), extra salt consumption on daily meals (OR: 1.5, 95% CI: 1.05–2), lack of sleep (OR: 2.6, 95% CI: 1.5–4.8), and consumption of white bread (OR: 1.7, 95% CI: 1.05–2.7) were related to increased risk of GERD.

          Conclusion

          Our findings showed lifestyle factors such as habit of quick eating, extra salt on regular meals, lack of sleep and use of white bread were associate with increased risk of GERD. However, habit of midnight snack, having dinner just before bedtime, lack of breakfast, smoking, drinking tea and coffee were not associated with increased risk of GERD. It is recommended to carry out a cohort study among the Iranian population to evaluate the effect of life-style risk factors on GERD.

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          Most cited references31

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          Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications.

          Howard Hampel, Neena Abraham, Hashem El-Serag (2005)
          The association of body mass index and gastroesophageal reflux disease (GERD), including its complications (esophagitis, Barrett esophagus, and esophageal adenocarcinoma), is unclear. To conduct a systematic review and meta-analysis to estimate the magnitude and determinants of an association between obesity and GERD symptoms, erosive esophagitis, Barrett esophagus, and adenocarcinoma of the esophagus and of the gastric cardia. MEDLINE search between 1966 and October 2004 for published full studies. Studies that provided risk estimates and met criteria on defining exposure and reporting outcomes and sample size. Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were pooled by using a random-effects model. Nine studies examined the association of body mass index (BMI) with GERD symptoms. Six of these studies found statistically significant associations. Six of 7 studies found significant associations of BMI with erosive esophagitis, 6 of 7 found significant associations with esophageal adenocarcinoma, and 4 of 6 found significant associations with gastric cardia adenocarcinoma. In data from 8 studies, there was a trend toward a dose-response relationship with an increase in the pooled adjusted odds ratios for GERD symptoms of 1.43 (95% CI, 1.158 to 1.774) for BMI of 25 kg/m2 to 30 kg/m2 and 1.94 (CI, 1.468 to 2.566) for BMI greater than 30 kg/m2. Similarly, the pooled adjusted odds ratios for esophageal adenocarcinoma for BMI of 25 kg/m2 to 30 kg/m2 and BMI greater than 30 kg/m2 were 1.52 (CI, 1.147 to 2.009) and 2.78 (CI, 1.850 to 4.164), respectively. Heterogeneity in the findings was present, although it was mostly in the magnitude of statistically significant positive associations. No studies in this review examined the association between Barrett esophagus and obesity. Obesity is associated with a statistically significant increase in the risk for GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight.
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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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              Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux.

              R Johnsen, Jesper Lagergren, Lena Nilsson … (2004)
              The aetiology of gastro-oesophageal reflux is largely unknown. The authors' aim was to examine the relation between lifestyle habits and gastro-oesophageal reflux symptoms. Participants of two consecutive public health surveys in Nord-Trondelag, Norway. In a case control study within the two public health surveys, 3153 individuals who in the second survey reported severe heartburn or regurgitation during the last 12 months were defined as cases, while 40 210 people without reflux symptoms constituted the control group. The risk of reflux symptoms was estimated and multivariately calculated as odds ratios in relation to exposure to tobacco smoking, alcohol, coffee, tea, table salt, cereal fibres, and physical exercise. There was a significant dose response association between tobacco smoking and reflux symptoms. Among people who had smoked daily for more than 20 years the odds ratio was 1.7 (95% confidence interval 1.5 to 1.9) compared with non-smokers. A similar positive association was found for table salt intake. The odds ratio for reflux was 1.7 (95% CI 1.4 to 2.0) among those who always used extra table salt compared with those who never did so. We found moderately strong negative associations between the risk of reflux and exposure to coffee, bread high in dietary fibre content, and frequent physical exercise. Intake of alcohol or tea did not affect the risk of reflux. Tobacco smoking and table salt intake seem to be risk factors for gastro-oesophageal reflux symptoms. Dietary fibres and physical exercise may protect against reflux. Alcohol, coffee, and tea do not seem to be risk factors for reflux.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electron Physician
                Journal ID (iso-abbrev): Electron Physician
                Journal ID (publisher-id): Electronic physician
                Title: Electronic Physician
                Publisher: Electronic physician
                ISSN (Electronic): 2008-5842
                Publication date Collection: April 2018
                Publication date (Electronic): 25 April 2018
                Volume: 10
                Issue: 4
                Pages: 6718-6724
                Affiliations
                [1 ]Associate Professor, Epidemiology & Biostatistics Department, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
                [2 ]PhD Candidate in Biostatistics, Paramedical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3 ]PhD Candidate in Nursing Education, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
                [4 ]Nursing Student, Qom Azad University, Qom, Iran
                [5 ]Nursing Student, Student Research Committee, Qom University of Medical Sciences
                [6 ]Operating Room Student, Student Research Committee, Qom University of Medical Sciences
                [7 ]M.Sc. in Nursing, Faculty Member, Nursing and Midwifery School, Qom University of Medical Sciences. Qom, Iran
                Author notes
                Corresponding author: Somayeh Momenyan. Paramedical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98.2537836145, Email: somy.momenyan@ 123456gmail.com
                Article
                Publisher ID: epj-10-6718
                DOI: 10.19082/6718
                PMC ID: 5984028
                PubMed ID: 29881536
                SO-VID: bedc5eaf-70cf-4be8-95c8-58b7991aaa4f
                Copyright © © 2018 The Authors
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 25 January 2017
                Date accepted : 12 December 2017
                Categories
                Subject: Original Article

                Keywords: gastroesophageal reflux disease,frequency scale,life-style factors,risk factor
                Data availability:
                Keywords: gastroesophageal reflux disease, frequency scale, life-style factors, risk factor

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