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Open Access Research article

Hormone replacement therapy is associated with gastro-oesophageal reflux disease: a retrospective cohort study

Helen Close1*, James M Mason1, Douglas Wilson1 and A Pali S Hungin2

Author Affiliations

1 Durham Clinical Trials Unit, Queen’s Campus, Wolfson Research Institute, University of Durham, University Boulevard, Stockton-on-Tees, TS17 6BH, UK

2 School of Medicine and Health, Queen’s Campus, Wolfson Research Institute, University of Durham, University Boulevard, Stockton-on-Tees, TS17 6BH, UK

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BMC Gastroenterology 2012, 12:56  doi:10.1186/1471-230X-12-56

Published: 29 May 2012

Abstract

Background

Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). Results of observational studies in women taking HRT rely on self-reporting of gastro-oesophageal symptoms and the aetiology of gastro-oesophageal reflux disease (GORD) remains unclear. This study investigated the association between HRT and GORD in menopausal women using validated general practice records.

Methods

51,182 menopausal women were identified using the UK General Practice Research Database between 1995–2004. Of these, 8,831 were matched with and without hormone use. Odds ratios (ORs) were calculated for GORD and proton-pump inhibitor (PPI) use in hormone and non-hormone users, adjusting for age, co-morbidities, and co-pharmacy.

Results

In unadjusted analysis, all forms of hormone use (oestrogen-only, tibolone, combined HRT and progestogen) were statistically significantly associated with GORD. In adjusted models, this association remained statistically significant for oestrogen-only treatment (OR 1.49; 1.18–1.89). Unadjusted analysis showed a statistically significant association between PPI use and oestrogen-only and combined HRT treatment. When adjusted for covariates, oestrogen-only treatment was significant (OR 1.34; 95% CI 1.03–1.74). Findings from the adjusted model demonstrated the greater use of PPI by progestogen users (OR 1.50; 1.01–2.22).

Conclusions

This first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance.

Keywords:
Gastro-oesophageal reflux disease; Hormone replacement therapy; Menopause