Study: Acid Reflux Prevalence Increasing

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Obesity Increase Likely to Blame, Researchers Say

By Salynn Boyles
WebMD Health News

Reviewed by Louise Chang, MD

Dec. 22, 2011 -- Heartburn and other symptoms of acid reflux seem to be much more common than they were a decade ago.

The prevalence of weekly heartburn and other symptoms of acid reflux rose nearly 50% over the last decade, according to one of the largest studies ever to examine the issue.

The study followed more than 30,000 people in Norway for 11 years. When the study started, 11.6% of the people reported acid reflux symptoms at least once a week. That percentage rose to 17.1% by the end of the study. That's a 47% increase.

Obesity May Explain Reflux Rise

The study doesn't explain why heartburn and other acid reflux symptoms rose, but obesity is the most likely reason for the findings. And that makes the finding relevant to the U.S. and other industrialized countries, says researcher Eivind Ness-Jensen of the Norwegian University of Science and Technology.

The findings are particularly troubling, Ness-Jensen says, because people who've had acid reflux for a long time may be more likely to develop cancer of the esophagus -- a once rare, but increasingly common malignancy.

Jensen's study didn't track esophageal cancer, and most people who have acid reflux don't develop esophageal cancer.

The American Cancer Society estimates that in 2011, nearly 17,000 new cases of esophageal cancer were diagnosed in the U.S. and almost 15,000 Americans died of the disease.

Along with heartburn, a defining symptom of gastroesophageal reflux disease (GERD), is acid reflux, which occurs when stomach contents leak backward into the esophagus.

About 1 in 5 Reflux Patients Had Symptoms Resolve on Their Own

In Jensen's study, the number of people reporting any acid reflux symptoms rose by 30%, and the prevalence of the most severe symptoms rose by 24%.

Among the other findings:

• Among women, new cases of acid reflux symptoms rose with age.
• Women younger than 40 were least likely to report acid reflux symptoms.
• Older men and women were equally likely to report new cases of acid reflux symptoms.
• About 1 in 5 patients had their symptoms resolve on their own, independent of medication.

The study appears online in the journal Gut.

Not All GERD Patients Overweight

More research is needed to understand why some patients get better over time, says New York City gastroenterologist Anthony Starpoli, MD.

"This is a very common problem, and it is interesting that there appear to be patients who get better," he says. "We don't know if it is because they were more careful about what they ate or if they lost weight, but it is worth finding out."

Starpoli, who is associate director of esophageal endotherapy at New York's Lenox Hill Hospital, says he is seeing a growing number of patients with GERD and esophageal cancer.

Many are overweight and have eating habits that go hand-in-hand with acid reflux, but others are not overweight and are very careful to eat well.

"This is not just a disease of older people and people who are overweight," Starpoli says. "I have many young patients whose weight is normal and they still have terrible reflux."

In addition to weight loss, lifestyle factors that can improve acid reflux include:

• Avoid large meals before bedtime. Eating meals at least two to three hours before lying down will give food time to empty from the stomach before bed.
• Avoid overeating. Eating four to five small meals is better than three large ones for avoiding heartburn and reflux.
• Avoid personal heartburn triggers. For some people it might be chocolate and caffeine. For others it might be fruit juices or high-fat foods.
• Stop smoking and avoid alcohol.

SOURCES: Ness-Jensen, E., Gut, Dec. 21, 2011.Eivind Ness-Jensen, doctoral candidate, HUNT Research Center, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.Anthony Starpoli, gastroenterologist, associate director of esophageal endotherapy, Lenox Hill Hospital, New York, N.Y.Press release, BMJ Group.

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