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Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux
  1. M Nilsson1,2,
  2. R Johnsen3,
  3. W Ye2,
  4. K Hveem3,4,
  5. J Lagergren1,2
  1. 1Department of Surgery, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
  2. 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
  4. 4HUNT Research Centre, Verdal, Norway
  1. Correspondence to:
    Dr M Nilsson
    Department of Surgery, Karolinska Hospital, SE-171 76 Stockholm, Sweden;


Background/Aim: The aetiology of gastro-oesophageal reflux is largely unknown. The authors’ aim was to examine the relation between lifestyle habits and gastro-oesophageal reflux symptoms.

Subjects: Participants of two consecutive public health surveys in Nord-Trondelag, Norway.

Methods: In a case control study within the two public health surveys, 3153 individuals who in the second survey reported severe heartburn or regurgitation during the last 12 months were defined as cases, while 40 210 people without reflux symptoms constituted the control group. The risk of reflux symptoms was estimated and multivariately calculated as odds ratios in relation to exposure to tobacco smoking, alcohol, coffee, tea, table salt, cereal fibres, and physical exercise.

Results: There was a significant dose response association between tobacco smoking and reflux symptoms. Among people who had smoked daily for more than 20 years the odds ratio was 1.7 (95% confidence interval 1.5 to 1.9) compared with non-smokers. A similar positive association was found for table salt intake. The odds ratio for reflux was 1.7 (95% CI 1.4 to 2.0) among those who always used extra table salt compared with those who never did so. We found moderately strong negative associations between the risk of reflux and exposure to coffee, bread high in dietary fibre content, and frequent physical exercise. Intake of alcohol or tea did not affect the risk of reflux.

Conclusions: Tobacco smoking and table salt intake seem to be risk factors for gastro-oesophageal reflux symptoms. Dietary fibres and physical exercise may protect against reflux. Alcohol, coffee, and tea do not seem to be risk factors for reflux.

  • GORD, gastro-oesophageal reflux disease
  • HUNT, Helseundersokelsen i Nord-Trondelag
  • BMI, body mass index
  • OR, odds ratio
  • gastro-oesophageal reflux
  • risk factor
  • aetiology
  • lifestyle
  • population based

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