Prevalence of gastroesophageal reflux disease in Moscow

Limited data exist to determine the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in the Russian population, which might be different from those in Western countries. This study was performed in Moscow on randomized 1065 adults aged ≥15 years. A validated reflux questionnaire comprising 72 questions and an additional 29 sub‐questions were used. The questions assessed (heartburn and regurgitation) and related (dyspepsia, dysphagia, odynophagia and chest pain) symptoms, the triggering factors of these symptoms, family history and data on demographic and socioeconomic features. GERD was defined as heartburn and/or regurgitation once a week or common. Of the 1065 participants, 42.1% were male and 57.9% were female. The prevalences of frequent and occasional symptoms were 17.6 and 22.1% for heartburn and 17.5 and 21.8% for regurgitation, respectively, over the last 12 months. The prevalence of GERD was found to be 23.6%. The rate of GERD was significantly higher in females than in males (15.4 vs. 29.5%, P < 0.001) and significantly increased as the age of the participants increased (P = 0.011). GERD was present in 20.4% of smokers, 24.2% of coffee drinkers, 21.5% of alcohol consumers and 45.9% of stressed participants. Although the rate of alcohol consumers was lower in those with GERD compared with those without GERD, the rate of coffee drinkers and stressed participants was higher among those with GERD. The rate of additional symptoms was higher even in participants complaining of regurgitation/heartburn rarely, compared with those without complaints. Using the same questionnaire, which makes it possible to compare the present results with those from different countries, we found the prevalence of GERD in Moscow to be 23.6%, one of highest in the Western populations. The rates of heartburn and regurgitation were found to be similar, which constitutes a different result than has been found in similar studies. Additional symptoms should be assessed, in all GERD patients even in the presence of rare complaints of regurgitation/heartburn.     

Tongue-like Barrett＇s esophagus is associated with gastroesophageal reflux disease

AIM： To test this hypothesis of barrett esophagus （BE） classified into two types and to further determine if there was any correlation between the shape of endoscopically suspected esophageal metaplasia （ESEM）, prevalence of reflux esophagitis （RE） and heartburn. METHODS： A total of 6504 Japanese who underwent endoscopy for their annual stomach check-up were enrolled in this study. BE was detected without histological confirmation that is ESEM. We originally classified cases of ESEM into 3 types based on its shape： Tongue-like （T type）, Dome-like （D type） and Wave-like （W type） ESEM. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a one-month period. RESULTS： ESEM was observed in 10.3% of 6504 subjects （ESEM 〈 1 cm, 9.4%; 1cm≤ESEM 〈 3 cm, 1.7%; ESEM≥3 cm, 0.5%）. The frequency of ESEM was significantly higher in males compared with female subjects. Statistical analysis showed that the prevalence of heartburn and RE were significantly higher in the T type ESEM than in the W type ESEM （P 〈 0.05）. CONCLUSION： The T type ESEM was strongly associated with reflux symptoms and RE whereas the W type ESEM was not associated with GERD.     

Prevalence of Dysphagia in Patients with Gastroesophageal Reflux in Germany

Dysphagia is an alarming symptom that raises the possibility of stricture or malignancy. This study compares the prevalence and severity of dysphagia symptoms in subjects with or without gastroesophageal reflux (GERD). In a population-based study, 500 residents of Cologne between the ages of 20 and 90 years [232 (46%) males and 268 (54%) females] were randomly selected from the city register and sent questionnaires with reflux-related questions. Two hundred sixty-eight replies (54%) were accepted into the study. Of these, 45% were men with a median age of 58 years. The median female age was 54 years. Thirty-four percent of the respondents (n=92) admitted having heartburn symptoms. There was no significant gender-based difference. There was little variation in reflux frequency between individual age groups. Twenty-three (25%) of the 92 respondents with reflux reported symptoms more than twice per week. Forty-five percent of this "reflux" group took medications for their heartburn. Swallowing difficulties, predominantly mild, were reported in 11.3% of the respondents. Dysphagia was significantly increased in the reflux group (28%) versus the normal group (3%) (p<0.001). Sixteen percent of respondents with mild and 65% of those with moderate to severe reflux symptoms reported additional dysphagia symptoms (p<0.001). Swallowing problems are common in patients with GERD. Approximately two thirds of patients with long-term and severe reflux symptoms also have dysphagia symptoms. Dysphagia should always be investigated by a physician.     

Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea

BACKGROUND AND AIMS: This study estimated the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Asan-si, Korea, as the prevalence is believed to be lower than in Western countries. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed on randomly selected 2,240 Asan-si residents aged between 18 and 69 yr. All respondents were interviewed at their homes or offices by a team of interviewers. RESULTS: Of the 1,902 eligible subjects, 1,417 (78.4%: male 762; female 655) were surveyed. The prevalence of heartburn occurring at least once a month, at least once a week, and at least twice a week was 4.71% (95% confidence interval (CI), 3.6-5.8), 2.0% (95% CI, 1.2-2.7), and 1.3% (95% CI, 0.7-1.9), respectively. The corresponding figures for acid regurgitation were 4.4% (95% CI, 3.3-5.5) and 2.0% (95% CI, 1.3-2.8), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). No significant difference was detected between sexes. The prevalence of heartburn was associated with increasing age (p < 0.001). Nineteen percent of our population reported at least one of the atypical symptoms, for instance, chest pain, dysphagia, globus sensation, asthma, bronchitis, pneumonia, or hoarseness. The frequency of frequent GERD among subjects reporting any of the atypical symptoms was 12.6%, which was higher than that of the subjects without atypical symptoms. Patients with typical reflux symptoms were more common among those with atypical symptoms, compared to those without such symptoms (p < 0.001). Using a logistic regression model after adjusting for age and sex, typical reflux symptoms were associated with chest pain (odds ratio (OR), 9.3; 95% CI, 5.9-14.7), dysphagia (OR, 6.4; 95% CI, 2.8-14.7), globus sensation (OR, 3.9; 95% CI, 1.5-9.7), hoarseness (OR, 4.3; 95% CI, 1.4-13.1), asthma (OR, 2.6; 95% CI, 1.4-4.8), and bronchitis (OR, 1.2; 95% CI, 0.6-2.3). CONCLUSION: The prevalence of GERD was 3.5% in this Korean population. Heartburn and acid regurgitation were significantly associated with chest pain, dysphagia, globus sensation, hoarseness, and asthma.     

Features of gastroesophageal reflux disease in women

OBJECTIVES: Gastroesophageal reflux disease (GERD) is as common in women as in men, and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in women and compared them to a cohort of disease- and age-matched men. METHODS: We studied 543 adults, both men and women, referred for evaluation because of symptoms or signs suggestive of GERD. All patients were assessed immediately before testing using a standardized symptom questionnaire. Endoscopic, ambulatory pH, and motility findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between the two groups, i.e., 341 men (mean age 54, age range 25-90) and 202 women (mean age 50, age range 22-80). RESULTS: Heartburn without esophagitis was noted in 38% of men and 55% of women patients. Hiatal hernia was noted in 28% of men and in 26% of women. There were no differences in the magnitude of esophageal acid exposure by pH criteria and motility abnormalities between the two groups. The prevalence of endoscopic stages of GERD (0-IV, Savary-Miller classification) was similar between the two groups (p > 0.1, chi2 test) but women were less likely to harbor Barrett's esophagus (p < 0.05, chi2 test). Quantitative esophageal symptom analysis revealed significantly higher symptom severity scores for heartburn (p < 0.01), regurgitation (p < 0.05), belching (p < 0.01), and nocturnal (p < 0.01) symptoms in women as compared to men. Women also experienced higher symptoms scores of lower abdominal symptoms, such as abdominal pain, diarrhea, and constipation (p < 0.01). CONCLUSIONS: Among symptomatic adults undergoing evaluation for GERD, women appear to have generally similar patterns of endoscopic severity of GERD as men but they are less likely to harbor Barrett's esophagus. The severity of symptoms in women is significantly more than in men and may contribute to earlier disease recognition and different disease management.     

Gastroesophageal reflux disease in a low-income region in Turkey

OBJECTIVES: Detailed population-based data regarding the prevalence and symptom profile of gastroesophageal reflux disease (GERD) in underdeveloped and developing Caucasian countries are lacking. The aim of this study was to determine the prevalence and clinical spectrum of GERD in a low-income region in Turkey. METHODS: We used a previously validated reflux questionnaire, which was translated into Turkish and culturally adapted. The questionnaire was applied to 630 randomly selected participants greater than 20 yr old living in a population of 8,857 adults, with a low mean income of 75 dollars/person/month. The reliability and reproducibility of the questionnaire were calculated using the kappa statistic (test-retest). Endoscopy and/or 24-h intraesophageal pH monitoring were used to ascertain its validity in identifying patients with reflux. RESULTS: The prevalence of GERD symptoms was 10% for heartburn, 15.6% for regurgitation, and 20% for either symptom experienced at least weekly (95% CI). Heartburn and regurgitation were associated with noncardiac chest pain (37.3%), dysphagia (35.7%), dyspepsia (42.1%), odynophagia (35.7%), globus, hoarseness, cough, hiccup, nausea, vomiting, belching, and NSAID use, but not with body mass index in both frequent and occasional symptom groups. The prevalence of heartburn symptoms, but not regurgitation, increased significantly with age. CONCLUSIONS: The prevalence of GERD in a low-income population in Turkey was similar to that of developed countries, although with a different symptom profile, namely, a lower incidence of heartburn and a higher incidence of regurgitation and dyspepsia. These findings support the contention that there are a large number of patients worldwide in underdeveloped nations with poorly recognized and largely undertreated GERD.     

Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran

AIM： To investigate the prevalence and risk factors of gastroesophageal reflux disease （GERD） symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS： In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms （heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough） as completed for each subject. RESULTS： The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% （237 subjects）. The prevalence was higher in older individuals （36.0% vs 28.9%, P 〈 0.05） and in those with other gastrointestinal complaints （51.0% vs 27.8%, P 〈 0.001）, but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week （36.2% vs 17.3%, P 〈 0.001）. GERD had a positive correlation with smoking （42.1% vs 27.8%, P 〈 0.001）, but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal antiinflammatory drugs （NSAIDs） consumption was also significant （40.2% vs 25.4%, P 〈 0.001）. CONCLUSION： The prevalence of GERD （33%） is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.     

Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population

BACKGROUND: The epidemiological aspects of heartburn and gastroesophageal reflux disease have been object of growing interest in the last decade because of its increasing prevalence and the complications of the disease. AIMS: To evaluate the prevalence of heartburn and gastroesophageal reflux disease as well as their main characteristics in the Brazilian urban population. METHODS: A national inquire enrolling 13,959 adults was conducted in 22 Brazilian cities. The inclusion criteria were the presence of heartburn at least once a week ("heartburn group") and age greater than 16 years old. Individuals with heartburn with frequency of more than once a week were considered as having gastroesophageal reflux disease (GERD group). Factors related to the complaint were asked such as predisposing factors, habits (tobacco, alcohol and coffee intake) and body mass index. In this populational study a probabilistic model was used. RESULTS: The results are presented in absolute and relative frequency, which were ponderated estimates of the respective population figures. The global prevalence of heartburn was 11.9% (1,651 persons). Heartburn once a week was present in 4.6% (637 persons) and GERD in 7.3% (1,014 persons). The average ages of both groups were similar (men: 36.9 +/- 15.0; women: 39.6 +/- 15.1 yrs). Females were more affected in both groups. The occurrence of GERD increased with age and was more prevalent after 55 years old. The body mass index was in the normal range and similar in both groups (men: 24.7 +/- 4.6; women: 25.3 +/- 5.2 kg/m(2)). In both groups the individuals related their symptoms to food intake, fatty and spicy foods (heartburn group: 64.7%, 28.5%, 17.7%; GERD group: 55.0%, 25.9%, 11.7% respectively). In GERD group, stress (24.2%), health problems (22.3%) were more related to the symptoms than in heartburn group (20.0% and 15.0% respectively). CONCLUSIONS: The global prevalence of heartburn (11.9%) is relatively high in the Brazilian urban population, although lower than the reported figure to other countries. Heartburn and GERD have higher prevalence in women and both are related to food intake, fatty and spicy foods; GERD is more prevalent in individuals older than 35 years old.     

Reflux gastro-œsophagien chez l’adulte jeune africain: cas des étudiants de l’Université du Burundi

Introduction

The Gastro-esophageal reflux disease (GERD) is an important public health issue, according to its high prevalence, its chronic evolution and the frequent solicitations of cares that it generates. Among students, it can constitute a cause of school absenteeism or failures. In particular, there has been no previous investigation of GERD in young adult in Burundi.

Goal

To estimate the prevalence of GERD among young adult, to describe the risk factors and the main clinical symptoms of GERD.

Methods

Cross-sectional study, curried out over July 2011 among students of University of Burundi, randomly recruited in literature department and in Science and Medicine faculties.

Results

400 students have been kept for the study, 279 males and 121 females (sex-ratio: 2.3). The mean age was 27years+/?4 years with extremes of 20 and 40 years. The GERD has been found among 111 students either a prevalence of 27.8%, CI95%=[23–32%]. According to GERD recurrence, 21% (84 among 400) either 75.6% of students with GERD had at least one episode per week (GERD recurrent). Among female students, the prevalence of GERD was 28.9%, CI95%=[21–38%] (35 students) while among males it was 27.3% CI95%=[22–33%] (76 students), p>0,05. The main symptoms of GERD were the heartburn alone in 81,1% CI95%=[72–88%], the heartburn associated to acid regurgitations in 16,2% CI95%=[10–25%] and the regurgitations alone in 2,7% CI95%=[1–8%]. The extra-digestive symptoms were described by 3% of students suffering from GERD.

Conclusion

The global prevalence of GERD is estimated to 27.8% and the recurrent GERD to 21% either 75.6% of students with GERD. The main risk factors described were the fat meals and the cooked banana. These rates seem to be among the highest.     

Prevalence, risk factors and impact of gastroesophageal reflux disease symptoms: a population-based study in South China

OBJECTIVE: There are few data on the epidemiology of gastroesophageal reflux disease (GERD) in South China. The aim of this study was to assess the prevalence of GERD symptoms in South China and to evaluate the impact on health-related quality of life. MATERIALS AND METHODS: A face-to-face interview was carried out in South China using a validated Chinese version of the Reflux Disease Questionnaire to assess the prevalence of GERD symptoms. A randomly clustered sampling of permanent inhabitants aged 18 to 90 years was carried out under stratification of urban and suburban areas. The impact of GERD symptoms on health-related quality of life was evaluated using the Chinese version of SF-36. RESULTS: A total of 3338 residents (1468 M, 1870 F) were investigated. Mean age of the responders was 42.6 +/- 16.4 years; response rate was 95%. The prevalence of heartburn and/or acid eructation occurring at least weekly was 6.2%. The age- and gender-adjusted point prevalence of GERD symptoms in South China is 2.3% (95% CI, 1.8%, 2.8%) according to the definition in this study. There was no difference in prevalence between male (2.6%) and female (2.4%) subjects and there was no significant association between age and prevalence of GERD symptoms. Divorced/widowed/separated subjects (OR 4.61; 95% CI, 2.15%, 9.89%) and subjects with a heavy burden of work (OR 3.43, 95% CI, 1.72%, 6.84%) were significantly more likely to report GERD symptoms. As compared with the general population, subjects with GERD symptoms experienced considerable impairment in quality of life. CONCLUSION: The prevalence of GERD symptoms in South China was much lower than that reported in Western countries. GERD had a negative impact on quality of life.     

Ineffective oesophageal motility： Manometric subsets exhibit different symptom profiles

AIM： To compare the demographic and clinical features of different manometric subsets of ineffective oesophageal motility （IOM; defined as ≥ 30% wet swallows with distal contractile amplitude 〈 30 mmHg）, and to determine whether the prevalence of gastro-oesophageal reflux differs between IOM subsets.
METHODS： Clinical characteristics of manometric subsets were determined in 100 IOM patients （73 female, median age 58 years） and compared to those of 100 age-and gender-matched patient controls with oesophageal symptoms, but normal manometry. Supine oesophageal manometry was performed with an eight-channel DentSleeve water-perfused catheter, and an ambulatory pH study assessed gastrooesophageal reflux.
RESULTS： Patients in the IOM subset featuring a majority of low-amplitude simultaneous contractions （LASC） experienced less heartburn （prevalence 26%）, but more dysphagia （57%） than those in the IOM subset featuring low-amplitude propagated contractions （LAP; heartburn 70%, dysphagia 24%; both P ≤ 0.01）. LASC patients also experienced less heartburn and more dysphagia than patient controls （heartburn 68%, dysphagia 11%; both P 〈 0.001）. The prevalence of heartburn and dysphagia in IOM patients featuring a majority of non-transmitted sequences （NT） was 54% （P = 0.04 vs LASC） and 36% （P 〈 0.01 vs controls）, respectively. No differences in age and gender distribution, chest pain prevalence, acid exposure time （AET） and symptom/reflux association existed between IOM subsets, or between subsets and controls.
CONCLUSION： IOM patients with LASC exhibit a different symptom profile to those with LAP, but do not differ in gastro-oesophageal reflux prevalence. These findings raise the possibility of different pathophysiological mechanisms in IOM subsets, which warrants further investigation.     

Role of clinical presentation in diagnosing reflux-related non-cardiac chest pain

INTRODUCTION: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health-care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux, such as heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD but in patients with NCCP the clinical diagnosis of reflux is difficult, and invasive methods or the omeprazole test are required for its detection. The aim of the present study was to evaluate the role of clinical presentation when diagnosing GERD among patients with NCCP. METHODS: Patients with NCCP underwent upper endoscopy, Bernstein and omeprazole tests. The patients were divided into two groups based on GER- or non-GER-related chest pain, and clinical presentation was compared between these two groups. Gastroesophageal reflux disease was considered positive when at least two methods were positive. RESULTS: From 78 NCCP patients (41 male; mean age 50.4 +/- 2.3 years), the chest pain was related to GERD in 35 patients (44.8%). The two groups were the same based on sex and age. The chest pain severity, site, radiation and relation to food, exercise, and sleep were equal in the two groups, except for two symptoms: pain that was relieved by antacid (P < 0.031) and presence of classical reflux symptoms (P < 0.009), seen in the GERD patients. With regard to recent patient history, heartburn and regurgitation symptoms were seen more frequently in GERD patients (P < 0.036 and P < 0.002, respectively). DISCUSSION: Clinical presentation is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux- and non-reflux-related NCCP, the symptoms of heartburn or regurgitation in the present or recent patient history are diagnostic for GERD-related chest pain.     

Use of a simple symptom questionnaire to predict Barrett's esophagus in patients with symptoms of gastroesophageal reflux

OBJECTIVE: Accurately predicting Barrett's esophagus (BE) in patients with gastroesophageal reflux disease (GERD) is difficult. Using logistic regression analysis of symptom questionnaire scores we created a model to predict the presence of BE. METHODS: We conducted a logistic regression analysis of symptom data collected prospectively on 517 GERD patients and created a prediction model based on patient gender, age, ethnicity, and symptom severity. RESULTS: There were 337 (65%) males and 180 (35%) females, of whom 99 (19%) had Barrett's esophagus (BE). Multiple logistic regression analysis was performed to determine the predictive ability of gender, age, and ethnicity along with symptoms of heartburn, nocturnal pain, odynophagia, presence of belching, dysphagia, relief of symptoms with food, and nausea. The only significant predictors (at the 0.05 level) were male gender, heartburn, nocturnal pain, and odynophagia (all with positive effects on the presence of BE) and dysphagia (which had a negative effect). A nomogram was produced to show the effect of a given predictor on the probability of having BE in the context of the effects of the other predictors, and to estimate the probability of having BE for a given individual. The mean score (+/-SD) for the BE patients in our sample was 397.4+/-46.2 with a range of 292-530. For the patients without BE, the mean score (+/-SD) was 351.3+/-60.3 with a range of 190 - 528 (p < 0.001). If screening for BE is performed at a score of 375 or more, our model would have a specificity of 63% with a sensitivity of 77% (95% CI 61-86% given the 63% specificity). CONCLUSIONS: By asking seven questions about symptom severity, clinicians may be able to assign a probability to the presence of BE, and thus, determine the need for endoscopy in GERD patients.     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

BACKGROUND AND AIM: Epidemiological studies have shown that 10-48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects. METHODS: A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week. RESULTS: Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD. CONCLUSION: Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

Background and Aim:  Epidemiological studies have shown that 10–48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects.
Methods:  A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week.
Results:  Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD.
Conclusion:  Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

Health-related quality of life and severity of symptoms in patients with Barrett's esophagus and gastroesophageal reflux disease patients without Barrett's esophagus

OBJECTIVES: The aims of this study were: 1) to compare the health-related quality of life (HRQL) of patients with Barrett's esophagus (BE) to that of patients with GERD who did not have BE; 2) to compare HRQL of gastroesophageal reflux disease (GERD) patients to that of normative data for the US general population; and 3) to examine the impact of GERD symptom frequency and severity on HRQL. METHODS: The SF-36 and a validated GERD questionnaire were administered to 107 patients with biopsy-proven BE and to 104 patients with GERD but no BE by endoscopy. Frequent symptoms were defined as symptoms that occurred at least once weekly. Severity of symptoms was rated on a scale from 1 to 4 (mild to very severe). RESULTS: In all, 85% of the GERD patients and 82% of BE patients completed the questionnaires. There was no difference in the scores of the eight subscales of the SF-36 between BE patients and those with GERD but without BE (p > 0.05). However, both groups scored below average on all subscales of the SF-36 compared to published US norms for an age- and gender-matched group. Using multivariable linear regression, the social functioning subscale of the SF-36 correlated with the presence of heartburn or acid regurgitation, severity of acid regurgitation, frequency of heartburn, frequency of acid regurgitation, and number of comorbidities. Similarly, the physical functioning subscale correlated with age, frequency of heartburn, and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and number of comorbidities. The bodily pain subscale correlated with the frequency of heartburn and the severity of dysphagia, whereas the role emotional subscale correlated with the frequency of heartburn and the presence of dysphagia. CONCLUSIONS: Although there were no differences in HRQL between BE and GERD patients, both groups scored below average on the subscales of the SF-36 compared to normal controls. GERD symptom frequency and severity were associated with bodily pain and with impaired social, emotional, and physical functioning, suggesting a profound impact on daily living.     

Prevalence of atypical symptoms and their association with typical symptoms of gastroesophageal reflux in Spain

BACKGROUND: The association between typical and atypical symptoms of gastroesophageal reflux (GER) has received little attention in population-based studies. This study therefore sought to examine the prevalence of atypical symptoms, and their association with typical GER symptoms in Spain. METHODS: A telephone survey using a validated questionnaire was conducted in 2002 on 2500 subjects aged 40-79 years, randomly selected from the general population of Spain. The questionnaire included items on typical GER symptoms (heartburn and acid regurgitation) and several atypical symptoms (chest pain, dysphagia, belching, dyspepsia, globus, hoarseness, hiccups, chronic cough and asthma). The association between typical GER symptoms and each atypical symptom was summarized using odds ratios obtained from logistic regression. RESULTS: The response rate was 71.2%. A total of 60.8% (95% confidence interval 59.0-62.8%) of subjects reported suffering from at least one atypical symptom during the year preceding the interview. The prevalence rates varied from 26.7% for hoarseness to 6.6% for asthma. The prevalence of atypical symptoms was higher among the 791 subjects with typical GER symptoms than among the 1709 subjects reporting no typical GER symptoms (79.6 versus 52.2%). It was also higher among those reporting frequent typical GER symptoms compared with those reporting occasional symptoms (87.8 versus 58%). After adjustment for age, sex, coffee, alcohol and tobacco consumption, and psychosomatic symptoms, an association (P<0.05) was observed between typical symptoms and the respective atypical symptoms, with odds ratios ranging from 1.4 for asthma to 4.6 for belching. After additional adjustment for the remaining atypical symptoms, chest pain, dysphagia, dyspepsia, belching and globus were each independently associated with typical reflux symptoms. CONCLUSION: The prevalence of atypical GER symptoms is extremely high. There is an association between typical and atypical GER symptoms, particularly chest pain, dysphagia, dyspepsia, belching and globus.     

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms.
METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance.
RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）.
CONCLUSION： The prevalence     

Caucasian ethnicity as a risk factor for more severe mucosal damage in gastroesophageal reflux disease

Background and aims

In the Western world, 10?C20?% of patients with GERD complain of at least weekly episodes of heartburn and/or acid regurgitation, while the corresponding value for GERD patients in Asia is <5?%. Reports of the risk factors for mucosal damage in patients with GERD are scarce. The aim of this study was to compare the severity of mucosal damage according to the Los Angeles system in Japanese and Caucasian residents of Japan who have GERD.

Methods

We conducted a retrospective cross-sectional study using 537 patients who visited St. Luke??s International Hospital and Mie University Hospital in Japan with symptoms of heartburn from January 2003 through December 2011. We divided the participants into two ethnic groups: 116 Caucasians (84 males and 32 females), mean age (SD) 43.8 (13.2) years old; and 375 Japanese (192 males and 183 females), mean age (SD) 53.2 (15.5) years old. Patients with a history of previous abdominal surgery or Helicobacter pylori eradication were excluded from the analysis. All patients were examined by esophagogastroduodenoscopy (EGD) to evaluate the severity of mucosal injury and hiatal hernia before medical treatment.

Results

With multivariate ordinal logistic regression analysis, age (OR 1.03, 95?% CI 1.02?C1.04, p?<?0.001), male gender (OR 2.71, 95?% CI 1.84?C4.01), Caucasian ethnicity (OR 1.65, 95?% CI 1.06?C2.58, p?=?0.0268), and the presence of hiatal hernia (OR 3.35, 95?% CI 2.06?C5.46, p?=?0.0012) were associated with more severe mucosal injury in GERD.

Conclusions

Patients with reflux symptoms tend to have more severe mucosal damage if they are male, older, Caucasian, or have a hiatal hernia. These patients should be evaluated by EGD more frequently.