Reflux disease linked to constipation

Laxative use is common among patients with gastroesophageal reflux disease (GERD), according to a study. This suggests an association between constipation and GERD.

The retrospective observational study included 118 patients (mean age, 69.7 years; 50 men) with reflux esophagitis (RE; n=83) and nonerosive reflux disease (NERD; n=35) who received maintenance acid-suppressive therapy for more than 1 year, as well as 61 patients (mean age, 69.4 years; 28 men) who received regular acid-suppressive therapy for reasons other than GERD.

GERD patients used laxative with significantly greater frequency than those without GERD (38.1 percent vs 21.3 percent; p=0.0283). Nevertheless, there were no between-group differences observed in dose frequency, with 38 and seven patients in the GERD group on daily and pre re nata (PRN) dosages, respectively, as opposed to 12 and 1 patients in the non-GERD group.

Finally, the type of laxative was similar in the two groups: 31 and 10 patients on osmotics, eight and one patients on stimulants, one and zero patient on Kampo, two and zero patients on newly categorized laxatives, and three and two patients on combination therapy, respectively.

Demographic factors associated with the onset of reflux, including body mass index (BMI), age, and sex, were comparable between the GERD and non-GERD groups.

While unclear, the mechanism underlying the relationship between GERD and constipation may involve gastric pressure. In slow transit constipation, specifically, stools are formed in proximal colon throughout the entire colon. As the stomach is displaced by the colon, intragastric pressure may increase. Furthermore, excessive strain and evacuation difficulty due to hard stools during a bowel movement may also contribute to gastric pressure.