Atrophic gastritis was related to decreased risk for symptomatic GERD, after adjusting for lifestyle factors in the twin population. This association was not confounded by genetic or familial factors shared in the twins.

A study sought to investigate the relationship between symptomatic gastroesophageal reflux disease (GERD) and atrophic gastritis while adjusting for a variety of known covariates, in addition to familial and genetic factors.

A co-twin control study with both dizygotic (DZ) and monozygotic (MZ) twins was carried out. By measuring serum pepsinogen, I (PGI) and pepsinogen II (PGII) with distinct cut-off values, atrophic gastritis was identified. A structured questionnaire that encompassed questions about medication use history, pain behind the breastbone, acid regurgitation, and heartburn symptoms was used to identify GERD. Patients were divided into three categories: total GERD, frequent (≥1/week), and less frequent GERD (<1/week).

The study involved a total of 12,533 twins, of which 18.7% had frequent GERD and 37.7% displayed less frequent GERD. Atrophic gastritis and GERD were inversely correlated, especially in cases with frequent GERD. The odds ratio (OR) was 0.52 when PGI<30 was utilized as the cut-off value for atrophic gastritis. The OR was 0.53 when PGI<70 and PGI/PGII<3 were chosen as the cut-off values for atrophic gastritis. When the study was limited to MZ or DZ twins, a decreased risk for GERD was also seen in individuals suffering from atrophic gastritis.

After controlling for heritable genetics and shared familiar factors, there was a consistent inverse relationship between atrophic gastritis and symptomatic GERD.