Gastroesophageal reflux disease as a cause of death: Analysis of fatal cases under conservative treatment

Background: Treatment of gastroesophageal reflux disease (GERD) with modern acid-suppressive agents is supposed to be effective and safe. However, the re have been only a few studies on the mortality in GERD today. In the 1960 s 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 issue d 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 include d in the study. The annual death rate was 0.20/100,000. The causes were hem orrhagic reflux esophagitis in 51.9%, aspiration pneumonia in 34.6%, perfor ation of esophageal ulcer in 9.6%, and spontaneous esophageal rupture with reflux esophagitis in 3.9%. Thirty-eight patients had been treated with ome prazole or an H-2 antagonist, and 44 patients (85%) had severe concomitant disease. Conclusion: The mortality in conservatively treated GERD has not d ecreased. Patients with menial disorder, heart disease, or alcoholism const itute the group in which risk of death from conservatively treated GERD is likely to be greatest.