Islami Farhad, Pourshams Akram, Nasseri-Moghaddam Siavosh, Khademi Hooman, Poutschi Hossein, Khoshnia Masoud, Norouzi Alireza, Amiriani Taghi, Sohrabpour Amir Ali, Aliasgari Ali, Jafari Elham, Semnani Shahryar, Abnet Christian C, Pharaoh Paul D, Brennan Paul, Kamangar Farin, Dawsey Sanford M, Boffetta Paolo, Malekzadeh Reza
Institute for Transitional Epidemiology and the Tisch Cancer Institute, Mount Sinai School of Medicine, New York, United States ; Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Middle East J Dig Dis. 2014 Apr;6(2):65-80.
BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease (GERD) and mortality at the general population level and they have shown mixed results. This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran. METHODS Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study (GCS). We identified 3107 deaths (including 1146 circulatory and 470 cancer-related) with an average follow-up of 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for multiple potential confounders. RESULTS Severe daily symptoms (defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants) were associated with cancer mortality (HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affect overall mortality. Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms. CONCLUSION We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality.
西方国家仅有少数研究在普通人群层面调查了胃食管反流病（GERD）与死亡率之间的关联，且结果不一。本研究在伊朗戈勒斯坦省一项基于人群的大型前瞻性研究中，调查了GERD症状与全因死亡率及特定病因死亡率之间的关联。
戈勒斯坦队列研究（GCS）的50001名参与者有关于GERD症状的频率、发病时间及患者自我感知严重程度的基线数据。我们确定了3107例死亡病例（包括1146例循环系统疾病相关死亡和470例癌症相关死亡），平均随访6.4年，并计算了经多种潜在混杂因素调整后的风险比（HR）和95%置信区间（CI）。
严重的每日症状（定义为干扰日常工作或每天导致夜间觉醒的症状，4.3%的参与者报告有此类症状）与癌症死亡率相关（HR 1.48，95%CI：1.04 - 2.05）。这种增加幅度太小，对全因死亡率没有明显影响。死亡率与GERD的发病时间或频率无关，轻度至中度症状也未增加死亡率。
我们观察到在一小部分有严重症状的个体中，GERD与癌症死亡率增加有关。大多数轻度至中度GERD患者可以放心，他们的症状与死亡率增加无关。
