S384 Menopause Is an Important Risk Factor for GERD and Its Complications in Women

Introduction: The association between gastroesophageal reflux disease (GERD) and menopause has been scarcely studied. Few studies suggest that declining estrogen levels with menopause may be associated with increased GERD. However, others propose that menopausal women taking hormone replacement therapy (HRT) have an increased risk of GERD. The aim of our study was to determine the risk of GERD and its complications in post-menopausal versus premenopausal women. Methods: We performed a population-based analysis using the IBM Explorys database (1999-2019), a pooled, national, de-identified clinical dataset. Inclusion criteria for post-menopausal women were aged 45-65 years with a diagnosis code of menopause. Premenopausal women were defined as age 30-45 years with no diagnosis or symptoms of menopause. GERD complications that were evaluated included Barrett’s esophagus, erosive esophagitis, and esophageal stricture. Exclusion criteria were pregnancy, obesity, foregut surgery, upper gastrointestinal dysmotility disorders. A subgroup analysis of the effect of hormonal therapy (oral contraceptives and HRT) in post-menopausal women was also conducted. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare outcomes between pre- and post-menopausal women with GERD. Chi-square test was used to compare groups. A multivariable logistic regression analysis was conducted to account for possible confounding covariates. Results: 22,500 (6.4%) post-menopausal women and 163,100 (2.0%) premenopausal women had GERD. Post-menopausal women were at a higher risk for GERD when compared to premenopausal women (OR 3.20, 95%CI 3.15–3.24, p< 0.0001). Regression analysis showed that post-menopausal women were 3.5 times more likely to have GERD when compared to premenopausal women. Menopause was a greater risk factor for GERD than smoking, alcohol, asthma, emphysema, and diabetes (Figure 1). Post-menopausal women with GERD had more esophageal strictures, erosive esophagitis, and Barrett’s esophagus when compared to premenopausal women (Table 1). Post-menopausal women on hormonal therapy (oral contraceptives or HRT) were more likely to have GERD as compared with those not taking any hormonal preparation (1.11, 1.04-1.20, P=0.0033). Conclusion: Women in menopause have a higher risk for developing GERD and its complications as compared to pre-menopausal women. The use of hormone replacement therapy does not alter that risk.Figure 1.: Forest Plot: Odds of having GERD in patients with the following risk factors.Table 1.: Comparison of GERD outcomes between menopausal and premenopausal women.