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The relationship between gastroesophageal reflux disease and the level of physical activity.

PRINCIPLES
Data on associations between physical activity and gastroesophageal reflux disease (GERD) have been inconsistent. Although experimental and clinical studies prove that exercise increases gastroesophageal reflux, epidemiological observations on the relationship between GERD and everyday physical effort deliver contradictory results. Our aim was to examine the association between the level of everyday physical activity and parameters of the disease (pH-metry, symptoms) in patients diagnosed with GERD.


METHODS
We assessed the level of physical activity in a survey of 100 consecutive GERD patients. All subjects had undergone 24-h pH monitoring in a tertiary setting and reported symptoms they experienced daily. Using the criteria of the short form of the International Physical Activity Questionnaire (7-day recall) we identified groups presenting with low (I), moderate (II) or high (III) levels of physical activity. The amount of physical activity was expressed as multiples of resting metabolic rate and minutes of performance during a week (METs-minute/week). For evaluation of relationships between everyday physical activity and pH-metric indices of GERD a multivariate regression analysis was performed. The parameters studied were adjusted for age, BMI, smoking and gender (as covariates).


RESULTS
We did not observe any association between the amount of everyday physical activity (expressed as log base 10 METs-minute/week) and pH-metric parameters of GERD evaluated 5 cm and 15 cm above the lower oesophageal sphincter (LES). Furthermore, we analyzed relationships between investigated parameters and covariates: age, BMI, smoking and gender. We found significant correlations only between the number of reflux episodes 15 cm above LES and gender (beta -0.25; p <0.05) and between the number of reflux episodes 5 cm above LES and age (beta -0.24; p <0.05). The number of self-reported symptoms did not differ among the three groups of physical activity level. It reached 6 in groups I and II, and 7 in group III (p = 0.07). However we must note that we found a weak, positive correlation between the number of symptoms reported by patients and METs-minute/week (r = 0.21, p <0.05).


CONCLUSIONS
In view of our results the level of everyday physical activity is not associated with symptoms of GERD. This observation should be confirmed in other populations with GERD diagnosed upon pH-metric criteria.