Gastroesophageal Reflux Disease and Related Conditions Are Associated With Increased Risk for Nontuberculous Mycobacterium Infection.

Abstract

Goals: We aimed to assess the relationship between nontuberculous mycobacterium (NTM) and gastroesophageal reflux disease (GERD) and associated conditions using a large international database.

Background: Several studies suggest increased incidence of NTM pulmonary disease in patients with GERD.

Study: Within TriNetX database of over 130 million patients from 16 countries, a test cohort of patients with ICD-10 codes for GERD after esophagogastroduodenoscopy (EGD) was compared with controls without a GERD diagnosis who underwent screening colonoscopy. Five additional test cohorts were created: GERD without esophagitis (NERD), GERD with esophagitis (ERD), esophageal stricture, Barrett's without dysplasia (BWOD), and Barrett's with dysplasia (BWD). Sequential diagnoses were allowed in the test cohorts. One-to-one propensity score matching was performed between the control group and each test group based on age, gender, ethnicity, BMI, comorbidities, use of oral contraceptives, NSAIDs, bisphosphonate, ferrous sulfate, or immunosuppressant agents. Kaplan-Meier and Cox proportional hazards models (HR) were utilized for time-to-event analysis in matched cohorts with the outcome of de novo NTM diagnosis.

Results: After matching, cohort populations included: GERD 982,194; NERD 772,557; ERD 287,803; esophageal stricture 72,545; BWOD 79,520; BWD 14,401. After analysis, most cohorts displayed increased risk of NTM diagnosis, but no between-group differences: GERD (HR2.024), NERD (HR2.06), ERD (HR1.758), esophageal stricture (HR1.875), BWOD (HR1.28), and BWD (HR2.781).

Conclusions: Our findings suggest a significant association between GERD and its complications with NTM. There was an increased risk of NTM in GERD patients compared with control and no relationship between severity of GERD and likelihood of contracting NTM.