A0194 - Hypogonadism and Testosterone Replacement Therapy Are Associated with a Higher Risk of GERD in Males: A National Cohort Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ahmed Eltelbany, MD, MPH

Cleveland Clinic
Cleveland, OH

Ahmed Eltelbany, MD, MPH¹, Yazan Abu Omar, MD², Rama Nanah, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Abdul Mohammed, MD¹, Madhusudhan Sanaka, MD³, Prashanthi Thota, MD⁴
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ⁴Cleveland Clinic, Cleveland, OH

Introduction: The risk of GERD among males with hypogonadism is relatively unknown. Furthermore, the association between gastroesophageal reflux disease (GERD) and testosterone replacement therapy (TRT) has not been well documented in literature. Precisely, the reported effect of exogenous testosterone on GERD has been conflicting in literature. The aim of our study is to determine the risk of GERD and its complications among males with hypogonadism and the risk of GERD and its complications with TRT versus those who did not receive TRT among males with hypogonadism.

Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years). Inclusion criteria for individuals included: males, age >18 with a diagnosis of “hypogonadism”. The effect of FDA approved testosterone preparations on GERD and Barrett’s esophagus (BE) was assessed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare the risk of GERD and its complications between males on TRT versus those not on TRT.

Results: Of the 70,398,640 individuals in the database from 1999 to May 2022, we identified 408,810 (0.58%) male patients with hypogonadism of whom 135,000 (33%) patients were diagnosed with GERD and 9,430 (2.3%) patients were diagnosed with BE. A total of 183,760 (44.9%) male patients with hypogonadism received TRT. Males with hypogonadism had a significantly higher risk of GERD (5.40, CI 5.36 – 5.43) and BE (5.13, CI 5.02 – 5.24). Furthermore, treatment with TRT was associated with a significantly higher risk of GERD (1.40, CI 1.38 – 1.42) and BE (1.23, CI 1.18 – 1.28) among males with hypogonadism compared to untreated males.

Discussion: In this large retrospective study, we found that males with hypogonadism had a significantly higher risk for GERD and its complications compared to men without hypogonadism. Unfortunately, treatment with TRT may further exacerbate that risk. Accordingly, males with hypogonadism should be closely monitored for GERD and its complications.

Figure: Risk of GERD and its complications in A: Males with Hypogonadism B: Hypogonadal males on testosterone replacement therapy

Variable	Patients with Hypogonadism		Patients without Hypogonadism N=31,019,340 (%)
Variable	TRT N=183,770 (%)	No TRT N=225,100 (%)	Patients without Hypogonadism N=31,019,340 (%)
Age >65	75,740 (41.2%)	97,390 (43.3%)	9,435,750 (30.4%)
Caucasian	157,350 (85.6%)	128,170 (56.9%)	9,631,910 (31.1%)
Obesity	67,180 (36.6%)	62,050 (27.6%)	1,944,090 (6.3%)
Smoker	30,060 (16.4%)	29,000 (12.9%)	1,887,270 (6.1%)
Alcohol Abuse	7,470 (4.1%)	8,230 (3.7%)	711,830 (2.3%)
Hiatal Hernia	540 (0.3%)	450 (0.2%)	2,597,410 (8.4%)
GERD	68,270 (37.1%)	66,750 (29.7%)	2,597,410 (8.4%)
Barrett's Esophagus	4,720 (2.6%)	4,710 (2.1%)	142,030 (0.46%)
Esophageal Stricture	2,410 (1.3%)	2,380 (1.1%)	81,390 (0.26%)
Esophageal Adenocarcinoma	140 (0.1%)	170 (0.1%)	36,020 (0.12%)

Table: Patient Demographics, GERD; gastro-esophageal reflux disease

Disclosures:

Ahmed Eltelbany indicated no relevant financial relationships.

Yazan Abu Omar indicated no relevant financial relationships.

Rama Nanah indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Ahmed Eltelbany, MD, MPH¹, Yazan Abu Omar, MD², Rama Nanah, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Abdul Mohammed, MD¹, Madhusudhan Sanaka, MD³, Prashanthi Thota, MD⁴. A0194 - Hypogonadism and Testosterone Replacement Therapy Are Associated with a Higher Risk of GERD in Males: A National Cohort Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.