Epidemiology and clinical characteristics of GERD in the Japanese population

We reviewed articles on the epidemiology and clinical characteristics of gastroesophageal reflux disease (GERD) in Japan to clarify these features of GERD in this country. Although the definition of GERD depends on the individual study, the prevalence of GERD has been increasing since the end of the 1990s. The reasons for the increase in the prevalence of GERD may be due to increases in gastric acid secretion, a decrease in the Helicobacter pylori infection rate, more attention being paid to GERD, and advances in the concept of GERD. More than half of GERD patients had non-erosive reflux disease, and the majority (87%) of erosive esophagitis was mild type, such as Los Angeles classification grade A and grade B. There were several identified risk factors, such as older age, obesity, and hiatal hernia. In particular, mild gastric atrophy and absence of H. pylori infection influence the characteristics of GERD in the Japanese population. We also discuss GERD in the elderly; asymptomatic GERD; the natural history of GERD; and associations between GERD and peptic ulcer disease and H. pylori eradication. We examined the prevalence of GERD in patients with specific diseases, and found a higher prevalence of GERD, compared with that in the general population, in patients with diabetes mellitus, those with obstructive sleep apnea syndrome, and those with bronchial asthma. We provide a comprehensive review of GERD in the Japanese population and raise several clinical issues.     

Association between diabetes mellitus and gastroesophageal reflux disease:A meta-analysis

AIM:To investigate whether there is a link between diabetes mellitus(DM) and gastroesophageal reflux disease(GERD).METHODS:We conducted a systematic search of Pub Med and Web of Science databases,from their respective inceptions until December 31,2013,for articles evaluating the relationship between DM andGERD.Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.A meta-analysis was performed to compare the odds ratio(OR)in DM between individuals with and without GERD using a fixed effect or random effect model,depending on the absence or presence of significant heterogeneity.Subgroup analyses were used to identify sources of heterogeneity.Publication bias was assessed by Begg’s test.To evaluate the results,we also performed a sensitivity analysis.RESULTS:When the electronic database and hand searches were combined,a total of nine eligible articles involving 9067 cases and 81 968 controls were included in our meta-analysis.Based on the randomeffects model,these studies identified a significant association between DM and the risk of GERD(overall OR=1.61;95%CI:1.36-1.91;P=0.003).Subgroup analyses indicated that this result persisted in studies on populations from Eastern countries(OR=1.71;9 5%C I:1.3 8-2.1 2;P=0.0 0 3)a n d i n y o u n g e r patients(mean age50 years)(OR=1.70;95%CI:1.22-2.37;P=0.001).No significant publication bias was observed in this meta-analysis using Begg’s test(P=0.175).The sensitivity analysis also confirmed the stability of our results.CONCLUSION:This meta-analysis suggests that patients with DM are at greater risk of GERD than those who do not have DM.     

睡眠障碍与功能性胃肠疾病

功能性胃肠疾病（FGID）是指存在消化道症状，但无法用器质性病变或生化异常来解释的消化道功能性疾病。近年来研究表明，FGID是生物-心理-社会综合因素作用的结果，一些心理因素如生活应激、社会压力、心理状态等通过大脑中枢神经系统和肠神经系统的共同作用而引起FGID的一系列症状和体征，是有动力改变、内脏敏感性增高和脑-肠轴调节障碍等多种病理生理异常所致。机体对应激事件反应中出现最早、最权威的客观体验是睡眠行为障碍。睡眠障碍患者将增加胃肠症状、溃疡、肠癌的发病率，并且大量的流行病学调查发现，FGID多伴有睡眠质量的下降以及睡眠障碍。     

Epidemiology of reflux symptoms and GORD

Gastro-oesophageal reflux disease (GORD) occurs when reflux of gastric contents causes troublesome symptoms and/or complications (the Montreal definition). GORD is a common condition with a substantial economical burden to the community and it has a significant negative effect on health-related quality of life (HRQoL) while endoscopic findings like erosive oesophagitis per se seem to correlate badly with the experienced HRQoL.The prevalence of GORD varies over the world for unknown reasons, but genetic differences, difference in the Helicobacter pylori prevalence and life style factors like obesity might influence.The prevalence is lowest in East Asia (2.5–9.4%) and higher in Mid (7.6–19.4%) and Western Asia (12.5–27.6%). The highest population-based prevalence is reported from Europe (23.7%) and the US (28.8%).GORD seems to be fairly stable over time both in terms of symptoms and erosive oesophagitis, but the prevalence seems to be increasing both in Asia and in the West.     

Esophageal Diverticula: Pathogenesis, Clinical Aspects, and Natural History

It has been gradually accepted that esophageal diverticula result from esophageal motor disorders rather than from primary anatomic abnormalities. Twenty-seven patients with these diverticula were evaluated with respect to pathogenesis, clinical aspects, diagnostic tests, therapy, and natural history for a mean of 27 months of followup. Thirteen diverticula were midesophageal, 11 were situated in the distal third of the esophagus, and 3 were in both regions. Esophageal dysmotility was observed in 85% of patients. Specific esophageal motor disorders were more frequent in association with diverticula of the distal third than in midesophageal diverticula, suggesting that they result from a pulsion mechanism. Traction was the possible mechanism in 27% of midesophageal diverticula. Endoscopic esophagitis was seen in one patient and abnormal acid reflux in 25% of the cases, mainly in patients with distal diverticula. Distal diverticula presented with more severe symptoms than did midesophageal diverticula, and 27% of those required surgical treatment. Patients with midesophageal diverticula seem to have a better prognosis than those with more distal disease.     

胃食管反流病患者生活质量调查187例

目的:调查消化门诊人群胃食管反流病(gastroesophageal reflux disease,GERD)生活质量状况.方法:针对安徽铜陵三家市级医院2008-06/08消化内科门诊连续就诊人群,根据国内通用的GERD临床诊断标准(RDQ总积分≥12分)和洛杉矶反流性食管炎(RE)内镜诊断标准进行GERD调查和诊断,采用中文版SF-36生存质量量表进行GERD患者生活质量状况地评估.所有调查资料使用Epi Data 3.0软件建立数据库,利用SPSS13.0做统计学分析.根据数据的分布特征,分别采用X2检验、非参数检验、两样本t检验.结果:三家市级医院消化内科门诊7 352例连续就诊患者中共调查诊断出GERD 199例.187例GERD患者实际参与了生活质量状况的调查,选取了374例同年龄同性别的正常健康人群进行了病例对照研究.结果显示,GERD病例组8个纬度生活质量评分、SF-36量表总分均明显低于健康对照组,有显著性差异(P<0.05).非糜烂性反流病(nonerosive reflux disease,NERD)组7个纬度生活质量评分、SF-36量表总分均明显低于反流性食管炎(reflux esophagitis,RE)组患者,有显著性差异(P<0.05).无论NERD或RE组女性患者生活质量量表总分均明显低于男性,有显著性差异(P<0.05).结论:GERD患者生活质量较正常健康人群明显下降;在NERD、女性患者中更为突出.精神心理因素可能在GERD发病中起到一定作用.     

The Association Between Obesity and GERD: A Review of the Epidemiological Evidence

The current epidemics of obesity and gastroesophageal reflux disease (GERD)-related disorders have generated much interest in studying the association between them. Results of multiple studies indicate that obesity satisfies several criteria for a causal association with GERD and some of its complications, including a generally consistent association with GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. An increase in GERD symptoms has been shown to occur in individuals who gain weight but continue to have a body mass index (BMI) in the normal range, contributing to the epidemiological evidence for a possible dose-response relationship between BMI and increasing GERD. Data are less clear on the relationship between Barrett's esophagus (BE) and obesity. However, when considered separately, abdominal obesity seems to explain a considerable part of the association with GERD, including BE. Overall, epidemiological data show that maintaining a normal BMI may reduce the likelihood of developing GERD and its potential complications.     

浙江省内科门诊人群胃食管反流病及危险因素流行病学调查

目的了解浙江省内科门诊人群胃食管反流病的患病率，分析与之相关的危险因素。方法流行病学调查采用整体随机抽样、反流性疾病问卷（reflex diagnostic questionnaire，RDQ）调查方式，并采用多种统计学方法进行统计分析。．结果浙江省内科门诊人群胃食管反流病的初筛患病率为7．28％，95％可信区间为6．87％～7．69％。不同性别、年龄、体力劳动强度、婚姻状况间胃食管反流病患病率差异有统计学意义（P〈0．05）。进食过饱、常饮酸性饮料、常食辛辣食物、油腻食物、常饮浓茶、常进甜食、吸烟、饮酒、便秘者胃食管反流病患病率明显升高，差异有统计学意义（P〈0．01）。单因素Logistic回归分析发现：性别、年龄、体力劳动强度、是否上夜班、婚姻状况是胃食管反流病的危险因素；多因素Logistic回归分析发现：年龄、是否上夜班、体力劳动强度、婚姻状况、进食过饱、常食油腻食物、常饮浓茶、常进甜食、便秘等可能是危险因素。结论问卷调查表是临床诊断胃食管反流病的一种简单、有效的方法。胃食管反流病有众多危险因素，临床上需引起高度重视。     

食管动力和反流事件在OSAHS发病机制中意义

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与胃反流性疾病(gastroesophageal reflux disease)的关系。 方法2013年2月至2014年6月期间就诊于新疆维吾尔自治区人民医院的OSAHS患者30例,采用多导睡眠监测、24 h多通道腔阻抗-pH监测和高分辨率胃肠动力学检查系统进行监测,观察食管上、下括约肌、食管动力学特点及反流事件相关指标,并与10例健康成人对照组比较,比较组间各测量指标差异。 结果OSAHS组较对照组食管上括约肌松弛持续时间、食管上括约肌松弛恢复时间、食管下括约肌长度、远端收缩积分平均值均减小,收缩前沿速度增加,差异均具有统计学意义(t＝－2.061、－2.044、－2.525、－2.076、2.522,P均<0.05)。OSAHS组与对照组中DeMeester评分中位数(M[P25;P75])分别为11.3[5.1;37.8]、3.8[2.8;11.1]分。食管近端反流总次数分别为41.5[23.8;65.3]、24.5[16.3;27.8]次,酸反流次数分别为20.0[10.0;32.0]、10.5[7.8;14.3]次。OSAHS组食管近端反流总次数、酸反流次数及DeMeester评分均较对照组增加,差异均有统计学意义(z＝－2.438、－2.361、－2.140,P均<0.05)。 结论OSAHS部分患者存在食管上、下括约肌结构和功能障碍,存在胃食管反流现象,食管近端反流以酸性物质为主。