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      Effects of Life style factors on the symptoms of gastro esophageal reflux disease: A cross sectional study in a Pakistani population

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          Abstract

          Background &Objective:

          Gastro esophageal reflux disease (GERD) broadly includes the whole spectrum of reflux disease symptoms like heartburn or acid regurgitation to endoscopic, reflux esophagitis or Barrett’s esophagus. Our aim therefore was to study the association between Gastroesophageal reflux disease symptoms and various lifestyle factors.

          Methods:

          A descriptive cross-sectional study was carried out in the outpatient department of Darul Sehat Hospital, Zubaida Medical Center and Liaquat National Hospital & Medical College, Karachi, Pakistan from January 2018 to October 2018. The selected candidates were asked to fill a validated GERD questionnaire and they were also asked about their lifestyle factors. Odds ratio and their 95% confidence interval were estimated using binary logistic regression with GERD symptoms as the study outcome.

          Results:

          A total of 2000 respondents completed the questionnaire. 69.3% gastroesophageal reflux disease cases were found in participants above 35 years of age while 56.9% subjects were male. The most common lifestyle factors associated with GERD were less exercise time (90.9%) (OR, 6.47; 95% CI, 4.91-8.53), 78.3% participants had habit of eating midnight snacks (OR, 5.08; 95% CI, 4.03-6.40), 87.3% participants reported less interval between dinner and sleep (OR, 6.98; 95% CI, 5.36-9.08). The most important factor relieving GERD symptoms was raising the head of bed during sleep (79.4%) while 43.3% subjects with the habit of post dinner walk reported fewer symptoms of GERD.

          Conclusion:

          Lifestyle factors particularly less physical activity, late evening meals, inadequate sleep, smoking and post dinner lying were found to be associated with GERD symptoms.

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          Most cited references22

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          Epidemiology of gastro-oesophageal reflux disease: a systematic review.

          A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated. An approximate prevalence of 10-20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%. The incidence in the Western world was approximately 5 per 1000 person years. A number of potential risk factors (for example, an immediate family history and obesity) and comorbidities (for example, respiratory diseases and chest pain) associated with GORD were identified. Data reported in this systematic review can be interpreted with confidence as reflecting the epidemiology of "true" GORD. The disease is more common in the Western world than in Asia, and the low rate of incidence relative to prevalence reflects its chronicity. The small number of studies eligible for inclusion in this review highlights the need for global consensus on a symptom based definition of GORD.
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            Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.

            Guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD) were published in 1995 and updated in 1999. These and other guidelines undergo periodic review. Advances continue to be made in the area of GERD, leading us to review and revise previous guideline statements. GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. These guidelines were developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee, and approved by the Board of Trustees. Diagnostic guidelines address empiric therapy and the use of endoscopy, ambulatory reflux monitoring, and esophageal manometry in GERD. Treatment guidelines address the role of lifestyle changes, patient directed (OTC) therapy, acid suppression, promotility therapy, maintenance therapy, antireflux surgery, and endoscopic therapy in GERD. Finally, there is a discussion of the rare patient with refractory GERD and a list of areas in need of additional study.
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              Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux.

              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
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Jan-Feb 2020
                : 36
                : 2
                : 115-120
                Affiliations
                [1 ]Shahid Ahmed, Associate Professor, Department of Medicine, Darul Sehat Hospital, Karachi, Pakistan
                [2 ]Sajjad Jamil, Consultant, Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi, Pakistan
                [3 ]Hafeezullah Shaikh, Assistant Professor, Department of Gastrenterology, National Institute of Liver and GI Diseases, Dow University of Health Sciences, & Consultant Zubaida Medical Center, Karachi, Pakistan
                [4 ]Maryam Abbasi, Research Coordinator, Darul Sehat Hospital, Karachi, Pakistan
                Author notes
                Correspondence: Dr. Hafeezullah Shaikh, National Institute of Liver and GI Diseases, Dow University of Health Sciences, & Zubaida Medical Center, Karachi, Pakistan. E-mail: hafeezmurad@ 123456gmail.com
                Article
                PJMS-36-115
                10.12669/pjms.36.2.1371
                6994865
                32063943
                eb7a214c-1bb2-44a3-9c48-1a9f1dc53124
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 July 2019
                : 04 November 2019
                : 16 November 2019
                Categories
                Original Article

                lifestyle,gastroesophageal reflux,smoking,sleep deprivation,exercise

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