Depression and Treatment with Antidepressants are Associated with the Development of Gastro-oesophageal Reflux Disease

E. Martín-Merino; A. Ruigómez; L. A. García Rodríguez; M.-A. Wallander; S. Johansson

Disclosures

Aliment Pharmacol Ther. 2010;31(10):1132-1140. 

In This Article

Abstract and Introduction

Abstract

Background The roles of depression and antidepressants in triggering reflux symptoms remain unclear.
Aim To compare the incidence of gastro-oesophageal reflux disease (GERD) in individuals with and without a depression diagnosis and to evaluate risk factors for a GERD diagnosis. The relationship between antidepressant treatment and GERD was also assessed.
Methods The Health Improvement Network UK primary care database was used to identify patients with incident depression and an age- and sex-matched control cohort with no depression diagnosis. Incident GERD diagnoses were identified during a mean follow-up of 3.3 years. Furthermore, we performed nested case-control analyses where odds ratios (OR) with 95% confidence intervals (CI) were estimated by unconditional logistic regression in multivariable models.
Results The incidence of GERD was 14.2 per 1000 person-years in the depression cohort and 8.3 per 1000 person-years in the control cohort. The hazard ratio of GERD in patients with depression compared with controls was 1.72 (95% CI: 1.60–1.85). Among patients with depression, tricyclic antidepressant use was associated with an increased risk of GERD (OR: 1.71; 95% CI: 1.34–2.20), while selective serotonin reuptake inhibitors were not associated with GERD.
Conclusions A depression diagnosis is associated with an increased risk of a subsequent GERD diagnosis, particularly in individuals using tricyclic antidepressants.

Introduction

Gastro-oesophageal reflux disease (GERD) is a chronic disease[1] that accounts for approximately 5% of all primary care consultations.[2] The prevalence of GERD varies in different parts of the world;[3] it affects 10–20% of adults in Europe and the USA, but only about 5% of adults in Asia.[4]

Depression is also widely reported in primary care and the prevalence of depression is approximately 11% in UK primary care.[5] Several studies have found an association between GERD and depression.[6–8] In addition, some medications used in psychiatric or psychological disorders (such as hypnotics, antipsychotics and antidepressants) may affect lower oesophageal sphincter (LES) tone, salivation or oesophageal motility and thus exacerbate reflux symptoms.[9]

In a previous study, we showed that individuals with a diagnosis of GERD are at risk of a subsequent diagnosis of depression.[5] The current study aims to evaluate the potential roles of depression and treatment with antidepressants in triggering reflux symptoms. The Health Improvement Network (THIN) UK primary care database was used to compare the incidence of GERD in a cohort of patients with a diagnosis of depression with that in a cohort of individuals with no such diagnosis. Other potential risk factors for a diagnosis of GERD, including the use of antidepressants and comorbidity status, were also evaluated.

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