Gastroesophageal reflux disease (GERD) is a common digestive disorder. Esophageal acid exposure (EAE) correlates significantly with GERD symptoms but accounts for only a small percentage of the variation in GERD symptom scores. Therefore, other factors are likely to play a role in GERD. In the December 2004 issue of Alimentary Pharmacology and Therapeutics, Joseph Zimmerman, MD, explored the relationship between EAE, smoking, and irritable bowel syndrome (IBS).
All 3 factors were found to be significant independent predictors of GERD, but smoking and IBS also modulated the effects of EAE on GERD symptoms. GERD symptom scores were higher in patients in whom 24-hour acid monitoring confirmed excessive acid exposure (n = 256) than in symptomatic patients with normal exposure to acid (n = 154). In both groups, patients with IBS symptoms had significantly (P < .001) higher GERD symptom scores. Smoking was associated with significantly (P < .001) higher GERD symptom scores in patients with normal acid exposure, but symptom scores were equally high in patients with excessive acid exposure, regardless of smoking status. Results of this study may be relevant for treatment decision-making.