Gastroesophageal reflux disease in monozygotic and dizygotic twins

Background & Aims: Gastroesophageal reflux disease (GERD) interferes with the quality of life and carries an increased risk for esophageal adenocarcinoma. We investigated genetic influence in the development of reflux. Methods: We compared concordance for reflux in monozygotic (MZ) and dizygotic (DZ) twins. All twins age 55 and older in the nationwide Swedish Twin Registry were invited to participate. Data were collected by computer-assisted telephone interviews. Reflux disease was defined by symptomatic heartburn or acid regurgitation occurring at least weekly. Results: A total of 2178 monozygotic, 3219 same-sex dizygotic, and 3014 unlike-sex dizygotic twin pairs provided information. Overall, 15.3% of the twins had reflux. In men, the intraclass correlation for reflux was 0.29 (95% confidence interval [Cl], 0.15-0.43) for monozygotic and 0.13 (95% Cl, 0.02-0.25) for dizygotic pairs. In women, the correlation was 0.33 (95% Cl, 0.22-0.44) for monozygotic and 0.14 (95% Cl, 0.04-0.24) for dizygotic pairs. For unlike-sex dizygotic pairs, the correlation was 0.06 (95% Cl, -0.01 to 0.14). Concordance for reflux was not caused by inherited obesity or alcohol use; inherited smoking may be a minor factor. Conclusions: The increased concordance for reflux in monozygotic pairs, compared with dizygotic pairs, indicates genetic rather than shared environmental effects. Heritability accounted for 31% (23%-39%) of the liability to reflux disease in this population.