Epidemiology of GERD

Epidemiology of Gerd

It has been estimated that more than 15 million Americans suffer from heartburn once a day , and an additional 45 million experiencing heartburn at least once a month.

The prevalence of this acid reflux disease in the population varies depending on whether the analysis is based on symptoms (primarily heartburn) or signs (i.e., esophagitis) of disease. When based on symptoms, Gastroesophageal reflux disease is common in Western countries. For example, in a nationwide population-based study by the Gallup Organization in the United States, 44% of the population reported having heartburn at least once a month. In another study, by Locke and colleagues, who mailed out 2200 validated self-report questionnaires to a predominantly white population residing in Olmsted County, Minnesota. The prevalence of heartburn and acid regurgitation in the previous 12 months were noted to be 42% and 45% respectively. Frequent symptoms (at least weekly) were reported by 20% of respondents, with an equal gender distribution across all ages. The majority reported that heartburn was of moderate severity and had a duration of 5 years or more, and only 5.4% reported a physician visit for reflux complaints within the previous year. More variable prevalence rates for symptomatic acid reflux disease have been reported from Europe, ranging from 5% in Switzerland to 27% in Finland.

In contrast, the true prevalence of esophagitis is very diffcult to determine, because healthy individuals rarely undergo upper GI endoscopies. Research suggests that about 7% of people in the United States have erosive esophagitis, whereas European studies identify prevalence rates ranging from 2% to 10% . Analyses of the prevalence GERD in men and women, show that nearly equal proportions of men and women are affected, but there is a male predominance of esophagitis and Barrett’s esophagus.

Increasing age is an important factor in the prevalence of gerd complications, probably the result of cumulative acid injury to the esophagus over time. In contrast, the prevalence of acid reflux disease and its complications is relatively low among the populations of Africa and Asia.In Singapore, for example, a cross-sectional study reported prevalence rates for reflux symptoms of 7.5% in Indian people, 0.8% in Chinese people, and 3.0% in Malay people. Possible reasons for this lower prevalence include low dietary fat intake, lower body mass index, and lower maximal acid output related to infection with Helicobacter pylori.

The prevalence of Gastroesophageal reflux disease is increasing in Western countries. Researchers have shown opposing time trends in the prevalence of peptic ulcer disease and GERD in the United States: rates of peptic ulcer disease and gastric cancer fell between 1970 and 1995, whereas the prevalence of gastro-esophageal reflux disease and esophageal adenocarcinoma rose significantly.

It has been speculated that the decreasing prevalence of H. pylori may be playing a contributory role in the increasing prevalence of GERD. Research data suggests that H. pylori-induced gastritis involves both the antrum and body of the stomach, affecting the parietal cells and thus reducing acid secretion and elevating gastric pH. This may have a protective influence on the esophageal mucosa in patients susceptible to acid regurgitation. Long-term epidemiological studies are needed to address this question more appropriately.

Other important epidemiological observations about acid reflux disease are that it is more common in white populations than in African American or Native American populations, family clustering has been reported, and it is rarely the cause of death. Gastro-esophageal reflux disease, however, is associated with considerable morbidity and with complications such as esophageal ulcerations (5%), peptic stricture (4%–20%), and Barrett’s esophagus (8%–20%). Furthermore, GORD as a chronic disease significantly impairs quality of life. When compared with other chronic medical conditions, the impairment of quality of life resulting from acid reflux disease is similar to, or even greater than, that resulting from arthritis, myocardial infarction, heart failure, or hypertension.