Clinical–Alimentary TractEffects of Estrogen With and Without Progestin and Obesity on Symptomatic Gastroesophageal Reflux
Section snippets
Study Population and Randomization
Detailed eligibility, recruitment methods, study population characteristics, hormone regimens, randomization, blinding, follow-up, and the main outcomes of the WHI hormones trials were published previously.22, 23, 24 Briefly, 27,347 postmenopausal women were recruited from 1993 to 1998 at 40 US clinical centers, primarily by mass mailings and other media announcements. Participants were aged 50–79 years at the initial screening, and were likely to reside in the study area for at least 3 years.
Baseline Characteristics
Among 27,347 randomly assigned women, ≈90% responded to the questions on heartburn symptoms both at baseline and at 1 year and were nearly equal in the active and placebo assignments in both trials (Figure 1). For the estrogen trial, 5549 (58.0%), 2776 (29.0%), 967 (10.1%), and 284 (3.0%) women reported no, mild, moderate, and severe heartburn at baseline, respectively. For the estrogen plus progestin trial, the corresponding figures were 9840 (65.1%), 3951 (26.1%), 1065 (7.0%), and 271 (1.8%).
Discussion
WHI is the first large randomized controlled trial to examine the effect of menopausal hormone therapy on the incidence and progression of symptomatic GER and also the first large prospective study on various measures of obesity to determine the most important physiologic factor for GER. Our data show that estrogen may modestly increase the incidence of symptomatic GER but does not affect its progression, and estrogen plus progestin affects neither the incidence nor the progression of
References (32)
- et al.
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota
Gastroenterology
(1997) - et al.
Gastroesophageal reflux among different racial groups in the United States
Gastroenterology
(2004) - et al.
The impact of gastroesophageal reflux disease on health-related quality of life
Am J Med
(1998) - et al.
The burden of selected digestive diseases in the United States
Gastroenterology
(2002) - et al.
Heartburn of pregnancy
Gastroenterology
(1977) - et al.
Lower sphincter of the opossum esophagus in pseudopregnancy
Gastroenterology
(1977) - et al.
Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins
Gastroenterology
(2007) - et al.
Postmenopausal hormone therapy and body composition–a substudy of the estrogen plus progestin trial of the Women's Health Initiative
Am J Clin Nutr
(2005) - et al.
The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants
Ann Epidemiol
(2003) - et al.
Risk factors associated with symptoms of gastroesophageal reflux
Am J Med
(1999)
Obesity: a challenge to esophagogastric junction integrity
Gastroenterology
Abdominal obesity and body mass index as risk factors for Barrett's esophagus
Gastroenterology
Gastro-oesophageal reflux disease
Lancet
Postmenopausal hormone therapy as a risk factor for gastroesophageal reflux symptoms among female twins
Gastroenterology
A new questionnaire for gastroesophageal reflux disease
Mayo Clin Proc
Prevalence of gastro-oesophageal reflux symptoms and the influence of age and sex
Scand J Gastroenterol
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Environmental - Lifestyle related factors
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Supported by Wyeth and by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.
The National Institutes of Health governed the overall design and conduct of the WHI study and approved the manuscript. Wyeth supplied study drugs but did not participate in any aspect of the aforementioned.
All authors declare that they have no conflict of interest to disclose.