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Estrogen Hormone Therapy May Raise Risk of Reflux: Study
NEW YORK (Reuters Health) May 08 - The results of a Swedish population-based twin study provide evidence that postmenopausal estrogen hormone therapy (HT) increases the risk of gastroesophageal reflux symptoms, independent of heredity, body weight, and tobacco use.
"The role of progestin HT, combined HT, and oral contraceptives is more uncertain," reports the research team in the April issue of Gastroenterology.
Dr. Helena Nordenstedt from Karolinska Institute, Stockholm, and colleagues investigated the relationship of oral contraceptives and postmenopausal HT to the risk of reflux symptoms using cross-sectional and prospective nested case-control analyses involving 4365 female twins with reflux and 17,321 without reflux.
In the cross-sectional analysis, they found that the risk of reflux was increased by 32% in ever users of estrogen HT (odds ratio, 1.32). "This association remained in the nested case-control analyses and increased slightly with higher body mass index."
They observed a similar pattern for the use of progestin in the cross-sectional analysis, but no association remained in the nested case-control analysis.
The positive association between HT and reflux symptoms was stronger among past users than among current users, suggesting that "previous exposure might actually be involved in the true etiology of the reflux disease," Dr. Nordenstedt and colleagues suggest.
The use of oral contraceptives was not associated with an increased risk of reflux symptoms.
If confirmed in future studies, "the postmenopausal woman considered for HT should be informed that reflux symptoms are a possible side effect, and if a woman who uses HT develops reflux symptoms, a treatment alternative to antireflux medication might be an attempt to stop using HT, particularly among obese women," the researchers conclude.
Gastroenterology 2008;134:921-928.
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