Several Factors Affect GERD Symptoms

Gastroesophageal reflux disease (GERD) is a common digestivedisorder. Esophageal acid exposure (EAE) correlates significantlywith GERD symptoms but accounts for only a small percentage ofthe variation in GERD symptom scores. Therefore, other factorsare likely to play a role in GERD. In the December 2004 issue ofAlimentary Pharmacology and Therapeutics, Joseph Zimmerman,MD, explored the relationship between EAE, smoking, and irritablebowel syndrome (IBS).

All 3 factors were found to be significant independent predictorsof GERD, but smoking and IBS also modulated the effects of EAEon GERD symptoms. GERD symptom scores were higher inpatients in whom 24-hour acid monitoring confirmed excessive acidexposure (n = 256) than in symptomatic patients with normal exposureto acid (n = 154). In both groups, patients with IBS symptomshad significantly (P < .001) higher GERD symptom scores. Smokingwas associated with significantly (P < .001) higher GERD symptomscores in patients with normal acid exposure, but symptomscores were equally high in patients with excessive acid exposure,regardless of smoking status. Results of this study may be relevantfor treatment decision-making.