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Allergy. 2015 Jun;70(6):697-702. doi: 10.1111/all.12615. Epub 2015 Apr 6.

Nocturnal GERD - a risk factor for rhinitis/rhinosinusitis: the RHINE study.

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Section of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
Departmet of ENT, Head and Neck Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Lung Clinic, Tartu University Hospital, Tartu, Estonia.
Faculty of Medicine, Department of Respiratory Medicine and Sleep, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Public Health Section for Environment Occupation and Health, Aarhus University, Aarhus, Denmark.



It has been suggested that gastroesophageal reflux disease (GERD) is a risk factor for developing rhinitis/rhinosinusitis, but data are lacking. This is a prospective 10-year follow-up study of a large multicenter cohort from Northern Europe, evaluating the relationship between nocturnal GERD and noninfectious rhinitis (NIR).


The study comprised 5417 subjects born between 1945 and 1973, who answered a questionnaire in 1999-2001 and again in 2010-2012. Noninfectious rhinitis was defined as having nasal obstruction, secretion, and/or sneezing without having the common cold. Odds ratios for developing NIR in relation to age, gender, BMI, smoking, asthma, and nocturnal GERD were calculated.


During the 10-year observation period, 1034 subjects (19.1%) developed NIR. Subjects reporting nocturnal gastroesophageal reflux in both 1999 and 2010 had more NIR in 2010 (2.8% vs 1.2%, P < 0.001). There was a significant dose-response relationship between the number of reflux episodes/week in 1999 and the risk of having NIR in 2010, P = 0.02. In the multiple regression adjusted for age, gender, BMI, tobacco smoke, and asthma, those with nocturnal GERD in 1999 (≥3 episodes of nocturnal gastroesophageal reflux symptoms per week) had an OR of 1.6 (95% CI 1.0-2.5, P = 0.03) to develop NIR in 2010. Smoking was associated both with an increased risk of developing NIR (30.7% vs 24.0%, P < 0.001) and with the development of nocturnal GERD.


This large, population-based, 10-year study indicates that nocturnal GERD was a risk factor for noninfectious rhinitis/rhinosinusitis. GERD should therefore be considered in patients with rhinitis of known and unknown origin.


gastroesophageal reflux disease; multicenter; noninfectious rhinitis; population; upper airway inflammation

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