Estrogen-only HRT may Increase complications in patients of GERD, study suggests
Cleveland, Ohio: Findings from a recent study in the journal Clinical Gastroenterology and Hepatology suggests that clinicians prescribing estrogen-only HRT to postmenopausal women should be aware of potential increased risks for GERD and its complications.
"If appropriate alternative HRT, such as progesterone-only therapy should be considered in patietns already suffering from reflux-related symptoms owing to its lesser GERD risk," Sherif Saleh, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, and colleagues wrote in their study.
Hormone replacement therapy (HRT) and female hormones are thought to play a role in gastroesophageal reflux disease (GERD). HRT, menoupaue, and pregnancy have all been reported as risk factors for GERD.
Estrogen and progesterone are suggested to confer their effect on the GI tract by increasing nitric oxide synthesis, muscle relaxant which decreases smooth muscle tone of the lower esophageal sphincter and esophageal body predisposing patients to gastroesophageal reflux. However, there is a need for elucidating the exact mechanism that these hormones play in GERD because menopuase (a risk factor for GERD) is tied to a decrease in the levels of estrogen and progesterone. Thus, there is no clarity on the exact relationship between the different hormonal therapies and GERD.
Against the above background, Dr. Saleh and colleagues aimed to determine the role and possible risk that estrogen and progesterone HRT pose for GERD development in postmenopausal women. In addition, they also assessed the relationship between HRT in postmenopausal women and GERD complications, such as esophageal stricture and Barrett's esophagus.
The researchers conducted a retrospective analysis of a private national cloud-based database called IBM Explorys. They identified five cohorts of postmenopausal women (ie, women ≥55 with diagnosis of postmenopausal state) were identified: (1) those on no HRT; (2) those on estrogen-only therapy; (3) those on progesterone-only therapy; (4) those on combined estrogen and progesterone therapy; and (5) those on selective serotonin receptor inhibitors (SSRIs), which served as a control group.
Each cohort was divided subsequently into subgroups based on diagnosis after initiation of HRT: GERD, nonerosive reflux disease, GERD with esophagitis (eGERD), Barrett's esophagus, and esophageal stricture.
Following were the key findings of the study:
- A total of 895,890 postmenopausal women were identified as not taking any form of HRT. There were 11.1% postmenopausal women on estrogen-only preparations and 1.0% on progesterone-only preparations. As compared with postmenopausal women on no HRT, there were increased ORs for the development of GERD (OR, 1.44; and OR, 1.48), nonerosive reflux disease (OR, 1.43; and OR, 1.49), eGERD (OR, 1.48; and OR, 1.42), Barrett's esophagus (OR, 1.57; and OR, 1.57), and esophageal stricture (OR, 1.88; and OR, 1.76) after starting either estrogen-only therapy or progesterone-only therapy, respectively.
- After adjusting for alcohol use, smoking, obesity, and White race, the use of estrogen-only preparations was still associated with increased risk for GERD (OR, 1.18), eGERD (OR, 1.38), Barrett's esophagus (OR, 1.19), and esophageal stricture (OR, 1.30). In contrast, the use of progesterone-only preparation in postmenopausal women did not have increased risk for any of the aforementioned diagnoses.
- There was no correlation between the duration of estrogen HRT and the occurrence of GERD and its complications.
- There were 4060 (0.5%) postmenopausal women on combined estrogen-progesterone preparations. As compared with postmenopausal women on no HRT, there was a significantly increased risk for developing GERD (OR, 1.23), nonerosive reflux disease (OR, 1.23), and eGERD (OR, 1.24), but not for Barrett's esophagus or esophageal stricture.
"Providers should be cognizant of potential increased risks for GERD and its complications associated with estrogen-only HRT; if suitable, alternatives such as progesterone-only therapy may be considered in certain settings such as bothersome reflux-associated symptoms and/or reflux complications," wrote the authors.
"Prospective trials are needed to further understand the relationship between HRT and GERD and its complications in postmenopausal women," they concluded.
Reference:
Saleh S, Trujillo S, Ghoneim S, Thomas C, Fass R. Effect of Hormonal Replacement Therapy on Gastroesophageal Reflux Disease and its Complications in Postmenopausal Women. Clin Gastroenterol Hepatol. 2022 Feb 11:S1542-3565(22)00138-0. doi: 10.1016/j.cgh.2022.01.058. Epub ahead of print. PMID: 35151861.
KEYWORDS: Clinical Gastroenterology and Hepatology, hormonal replacement therapy, postmenopausal women, GERD, gastroesophageal reflux disease, Sherif Saleh, HRT, menopause, complications, Barrett's esophagus, hormone therapy, estrogen, progesterone
