Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease

作者：Benson Victoria S; Mullerova Hana; Vestbo Jorgen; Wedzicha Jadwiga A; Patel Anant; Hurst John R

来源：Respiratory Medicine, 2015, 109(9): 1147-1154.

DOI：10.1016/j.rmed.2015.06.009

• Chronic obstructive pulmonary disease
• Cohort study
• Epidemiology
• Gastro-oesophageal reflux disease

Aim: To determine factors, overall and by sex, associated with self-reported gastro-oesophageal reflux disease (GORD) in chronic obstructive pulmonary disease (COPD) patients, and to evaluate relationships between GORD, its modification by acid suppression medications (Proton Pump Inhibitors [PPI]/histamine-2 receptor antagonists [H2RA]) and exacerbations of COPD and mortality.
Methods: Logistic regression was used to determine factors associated with GORD; Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for GORD and risk of exacerbation and death.
Results: Among 2135 COPD patients from the ECLIPSE cohort, 547 patients self-reported GORD, with female preponderance; 237 were taking PPI/H2RA. Risk factors for GORD did not differ by sex. When compared to patients who did not report GORD or use of PPI/H2RA, patients with GORD and taking PPI/H2RA had a significantly increased risk of exacerbation (HR - 1.58, 95% CI - 1.35-1.86); risk was also increased for patients reporting GORD only or PPI/H2RA use only (HR = 1.21 [1.04-1.40] and 1.33 [1.08 -1.65], respectively). Similar findings were observed for risk of hospitalised exacerbation. GORD was not associated with mortality.
Conclusion: GORD in COPD patients is highly prevalent, and risk factors did not differ by sex. Use of PPI/H2RA and self-reported GORD were associated with increased risk of moderate-to-severe and hospitalised exacerbations.

• 出版日期2015-9