Gastroesophageal Reflux Disease as a Cause of Death: Analysis of Fatal Cases under Conservative Treatment

Abstract

Background: Treatment of gastroesophageal reflux disease (GERD) with modern acid-suppressive agents is supposed to be effective and safe. However, there have been only a few studies on the mortality in GERD today. In the 1960s the mortality was 0.10?0.17/100,000 per year. Methods: From 1990 to 1995, according to Statistics Finland, 78 official death certificates were issued in which GERD was stated to have been the immediate or a primary cause of death. Results: On completion of analysis data on 52 patients were included in the study. The annual death rate was 0.20/100,000. The causes were hemorrhagic reflux esophagitis in 51.9%, aspiration pneumonia in 34.6%, perforation of esophageal ulcer in 9.6%, and spontaneous esophageal rupture with reflux esophagitis in 3.9%. Thirty-eight patients had been treated with omeprazole or an H₂ antagonist, and 44 patients (85%) had severe concomitant disease. Conclusion: The mortality in conservatively treated GERD has not decreased. Patients with mental disorder, heart disease, or alcoholism constitute the group in which risk of death from conservatively treated GERD is likely to be greatest.