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中生网 > 医药行业 > 医药进展 > 绝经后激素疗法可增加胃食管反流病风险

绝经后激素疗法可增加胃食管反流病风险

更新:2008年10月16日 阅读次数: 【字体:
September 9, 2008 — The risk for gastroesophageal reflux disease (GERD) is increased for postmenopausal use of estrogens, selective estrogen receptor modulators (SERMs), or over-the-counter (OTC) hormone preparations, according to the results of a prospective cohort study reported in the September 8 issue of Archives of Internal Medicine.

"Previous studies suggest that elevated levels of estrogen and progesterone, either through endogenous or exogenous sources, increase gastroesophageal reflux," write Brian C. Jacobson, MD, MPH, from Boston University Medical Center in Massachusetts, and colleagues. "Support for this theory includes observations that lower esophageal sphincter (LES) pressures decrease during pregnancy and with the use of sequential oral contraceptives. In addition, postmenopausal hormone (PMH) use may increase the risk of GERD symptoms among overweight and obese women."

The investigators analyzed data from 51,637 postmenopausal women enrolled in the Nurses' Health Study who provided data on the use of PMH therapy biennially since 1976, as well as information about symptoms of GERD in 2002.

GERD symptoms were reported by 12,018 women (23%) in the study cohort. Compared with women who never used PMHs, those who did use them had an elevated risk of developing GERD symptoms. The multivariate odds ratio (OR) for the risk for GERD symptoms was 1.46 (95% confidence interval [CI], 1.36 – 1.56) for past hormone users, 1.66 (95% CI, 1.54 – 1.79) for current users of estrogen only, and 1.41 (95% CI, 1.29 – 1.54) for current users of combined estrogen and progesterone.

Increasing estrogen dosage and duration of use were linked to increased risk for GERD symptoms (P <.001 for each). For GERD symptoms, OR was 1.39 (95% CI, 1.22 – 1.59) for current SERM users and 1.37 (95% CI, 1.16 – 1.62) for women currently using OTC hormone preparations.

"Postmenopausal use of estrogens, [SERMs], or OTC hormone preparations is associated with a greater likelihood of symptoms of GERD," the study authors write. "This suggests a hormonal component to the pathophysiologic characteristics of GERD in women."

Limitations of this study include the use of a questionnaire to define symptoms of GERD and an inability to rule out the possibility that women who use hormonal therapies are more likely to report and seek therapy for symptoms.

"As the current US population ages, there may be increasing numbers of women seeking both medical and complementary therapies for menopause-related symptoms and breast cancer or osteoporosis prevention," the study authors write. "These women should be counseled about the potential for symptoms of GERD associated with hormone therapies."

Dr. Jacobson has been a consultant to Ortho-McNeil Janssen Scientific Affairs, LLC, and is supported by the National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health. Second author Dr. Moy is supported by a career development award from the Friends of Mel Foundation.

Arch Intern Med. 2008;168:1798–1804.
关键词:绝经 激素疗法
相关栏目:医药行业 医药进展
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