Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study

  • Shiro ImagamaEmail author
  • Kei Ando
  • Kazuyoshi Kobayashi
  • Masaaki Machino
  • Satoshi Tanaka
  • Masayoshi Morozumi
  • Shunsuke Kanbara
  • Sadayuki Ito
  • Taisuke Seki
  • Takashi Hamada
  • Shinya Ishizuka
  • Hiroaki Nakashima
  • Naoki Ishiguro
  • Yukiharu Hasegawa
Original Article



The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study.


A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(−) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined.


Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05).


This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Gastroesophageal reflux disease Lumbar kyphotic change Aggravation of spinal inclination Decreased back muscle strength Sarcopenia 



We are grateful to the staff of the Comprehensive Health Care Program held in Yakumo, Hokkaido; to Mr. Masato Kako and Ms. Azusa Kayamoto in the Department of Rehabilitation, Nagoya University Hospital; to Ms. Aya Hemmi and Ms. Hiroko Ino at Nagoya University; and to all the staff of the central clerk desk in Nagoya University Hospital for their assistance throughout this study.


This study was supported by Japanese Ministry of Health, Labor, and Welfare Grants-in Aid for Scientific Research (C) (18K09102). No other funds were received in support of this work.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest except for this national grant.

Supplementary material

586_2019_6139_MOESM1_ESM.pptx (139 kb)
Supplementary file1 (PPTX 139 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shiro Imagama
    • 1
    Email author
  • Kei Ando
    • 1
  • Kazuyoshi Kobayashi
    • 1
  • Masaaki Machino
    • 1
  • Satoshi Tanaka
    • 1
  • Masayoshi Morozumi
    • 1
  • Shunsuke Kanbara
    • 1
  • Sadayuki Ito
    • 1
  • Taisuke Seki
    • 1
  • Takashi Hamada
    • 1
  • Shinya Ishizuka
    • 1
  • Hiroaki Nakashima
    • 1
  • Naoki Ishiguro
    • 1
  • Yukiharu Hasegawa
    • 2
  1. 1.Department of Orthopaedic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of RehabilitationKansai University of Welfare SciencesKashiwaraJapan

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