• Shiro Imagama, Yukiharu Hasegawa, Norimitsu Wakao, Kenichi Hirano, Nobuyuki Hamajima, and Naoki Ishiguro.
• Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan. imagama@med.nagoya-u.ac.jp
• Eur Spine J. 2012 Nov 1; 21 (11): 2149-57.

ObjectiveThe objectives of this study was to clarify the relationship between kyphosis and gastroesophageal reflux disease (GERD) by evaluation of spinal alignment, obesity, osteoporosis, back muscle strength, intake of oral drugs, and smoking and alcohol history in screening of a community population to determine the factors related to GERD symptoms. GERD increases with age and is estimated to occur in about 30% of people. Risk factors for GERD include aging, male gender, obesity, oral medicines, smoking, and alcohol intake. It has also been suggested that kyphosis may influence the frequency of GERD, but the relationship between kyphosis and GERD is unclear.Subjects And MethodsWe examined 245 subjects (100 males and 145 females; average age 66.7 years old) in a health checkup that included evaluation of sagittal balance and spinal mobility with SpinalMouse, GERD symptoms using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire, body mass index, osteoporosis, back muscle strength, number of oral drugs taken per day, intake of nonsteroidal anti-inflammatory drugs (NSAIDs), intake of bisphosphonates, and smoking and alcohol intake.ResultsMultivariate logistic regression analysis including all the variables showed that lumbar lordosis angle, sagittal balance, number of oral drugs taken per day, and back muscle strength had significant effects on the presence of GERD (OR, 1.10, 1.11, 1.09 and 1.03; 95% CI, 1.03-1.17, 1.02-1.20, 1.01-1.18 and 1.01-1.04; p = 0.003, 0.015, 0.031 and 0.038, respectively). The other factors showed no association with GERD.ConclusionThis study is the first to show that lumbar kyphosis, poor sagittal balance; increased number of oral drugs taken per day, and decreased back muscle strength are important risk factors for the development of GERD symptoms. Thus, orthopedic surgeons and physicians should pay attention to GERD in elderly patients with spinal deformity.

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