Gastro-esophageal Reflux Disease in Lebanese Adults: Effects on Quality of Life and Correlates

Abstract

Background: Gastroesophageal reflux disease (GERD) is a common disorder which has a detrimental impact on patients' quality of life (QOL). The Reflux-Qual Short form (RQS) is an eight-item instrument, developed for measurement of GERD's effect on QOL. Objective: Our primary objective was to validate the RQS in Lebanon; a secondary objective was to investigate the potential risk factors of GERD in the same sample. Methods: A questionnaire was administered face-to face to a sample of Lebanese adults all over Lebanon. The 970 participants were classified as GERD positive and GERD negative based on the presence of heartburn and/or regurgitation at least once per week and/or physician-made diagnosis of GERD. Psychometric properties of the RQS were evaluated, significant predictors of lower QOL and GERD associates were assessed. Results: The RQS showed a high internal consistency (Cronbach's alpha = 0.967) and an adequate factorial structure. A higher number of symtoms (β=-0.364), the presence of any disease of the digestive system (β=-0.186), the presence of GERD (β=-0.176), having a worse psychological state (β=-0.105), a higher BMI (β=-0.091), and the presence of any heart or artery disease (β=-0.088) or renal disease (β=-0. 087) were all associated with lower RQS scores. The most notable risk factors for the occurrence of GERD, were older age (ORa=3.10, 95%CI:2.15-4.46), a higher education (ORa=2.53, 95%CI:1.74-3.68), eating thyme (ORa=1.73, 95%CI:1.28-2.32), citrus (ORa=1.34, 95%CI:1.03-1.75), chocolate (ORa=1.29, 95%CI:0.99-1.69), garlic or onions (ORa=1.51, 95%CI:1.11-2.04) and cucumber (ORa=1.60, 95%CI:1.21-2.12), and drinking carbonated beverages (ORa=1.62, 95%CI:1.30-2.03) were all associated with the occurrence of GERD. Drinking milk (ORa=0.72, 95%CI: 0.57-0.91) and the increasing meals frequency (ORa=0.60, 95%CI:0.41-0.88) had protective effects on GERD occurrence. Subjects with asthma (ORa=8.35, 95%CI:2.17-32.22), with any disease related to the digestive system (ORa=4.97, 95%CI:2.67- 9.25), with diabetes mellitus (ORa=2.74, 95%CI:1.38-5.43) and those who had a family member suffering from GERD (ORa=3.73, 95%CI:1.99-7.02) tended to be more prone to get GERD. Moreover, DifenB12® (betamethasone, diclofenac, vitamin B12) (ORa=69.186, 95%CI:3.41- 1405.31), ibuprofen® (ORa=2.76, 95%CI:1.66-4.61) and iron supplements (ORa=1.62, 95%CI:0.98-2.68) were associated with higher GERD. Conclusion: The RQS is a simple, 8-items instrument specific to GERD, sensitive to betweensubject differences. The frequency and the multitude of GERD symptoms lowered the RQS score. Some socio-demographic factors, lifestyle and diet habits, concomitant diseases, and the use of certain drugs were associated with increased GERD risk.