Gastroesophageal Reflux Disease and overall and Cause-specific Mortality: A Prospective Study of 50000 Individuals

Farhad Islami, Akram Pourshams, Siavosh Nasseri-Moghaddam, Hooman Khademi, Hossein Poutschi, Masoud Khoshnia, Alireza Norouzi, Taghi Amiriani, Ali Aliasgari, Elham Jafari, Shahryar Semnani, Christian C Abnetc, Paul D Pharaoh, Paul Brennan, Farin Kamangar, Sanford M. Dawsey, Paolo Boffetta, Reza Malekzadeh



Only a few studies in Western countrieshave investigated the association between gastroesophageal reflux disease(GERD) and mortality at the general population level and they have shown mixedresults. This study investigated the association between GERD symptoms andoverall and cause-specific mortality in a large prospective population-based studyin Golestan Province, Iran.


Baseline data on frequency, onset time,and patient-perceived severity of GERD symptoms were available for 50001participants in the Golestan Cohort Study (GCS). We identified 3107 deaths(including 1146 circulatory and 470 cancer-related) with an average follow-upof 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals(CI) adjusted for multiple potential confounders.


Severe daily symptoms (defined assymptoms interfering with daily work or causing nighttime awakenings on a dailybases, reported by 4.3% of participants) were associated with cancer mortality(HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affectoverall mortality. Mortality was not associated with onset time or frequency ofGERD and was not increased with mild to moderate symptoms.


We have observed an association withGERD and increased cancer mortality in a small group of individuals that hadsevere symptoms. Most patients with mild to moderate GERD can be re-assuredthat their symptoms are not associated with increased mortality.


Cardiovascular disease; Esophageal cancer; Gastroesophageal reflux disease; Mortality

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