Zgaga – Epidemiologia

Zgaga
Epidemiologia

Choroba refluksowa przełyku (GERD) jest powszechnym zaburzeniem przewodu pokarmowego, z objawem dominującym w postaci zgagi, której częstość występowania wykazuje znaczne zróżnicowanie geograficzne. W krajach zachodnich, zwłaszcza w Ameryce Północnej, GERD dotyka 18,1-27,8% populacji, a globalnie około 13% osób doświadcza objawów co najmniej raz w tygodniu. W Europie rozpowszechnienie wynosi 8,8-25,9%, natomiast w Azji Wschodniej jest niższe (2,5-8%). Wzrost częstości występowania GERD obserwuje się szczególnie wśród młodszych dorosłych (30-39 lat). Czynniki ryzyka obejmują wiek, płeć, rasę, otyłość, palenie tytoniu, stres, historię rodzinną, dietę oraz infekcję Helicobacter pylori. Nieleczona choroba może prowadzić do powikłań takich jak refluksowe zapalenie przełyku (6,4-15,5% w populacjach poddanych endoskopii), przełyk Barretta (2-5,6% w USA) oraz gruczolakorak przełyku, którego ryzyko wzrasta 11-40-krotnie u pacjentów z przełykiem Barretta.

Epidemiologia zgagi (GERD)

Zgaga (heartburn) jest jednym z najczęstszych objawów choroby refluksowej przełyku (GERD – Gastroesophageal Reflux Disease), która stanowi powszechne zaburzenie przewodu pokarmowego na całym świecie. Epidemiologia zgagi i GERD wykazuje znaczne zróżnicowanie geograficzne, a jej rozpowszechnienie stale wzrasta na przestrzeni ostatnich dekad, co czyni tę chorobę istotnym problemem zdrowia publicznego.¹²

Rozpowszechnienie geograficzne zgagi i GERD

Rozpowszechnienie GERD wykazuje wyraźne zróżnicowanie geograficzne. W krajach zachodnich, szczególnie w Ameryce Północnej, GERD dotyka od 18,1% do 27,8% populacji, ze średnią około 20% dorosłych zgłaszających regularne objawy.¹² W badaniach populacyjnych stwierdzono, że około 13% światowej populacji doświadcza objawów GERD co najmniej raz w tygodniu.¹

W Europie dane epidemiologiczne wskazują na rozpowszechnienie GERD na poziomie 8,8%-25,9%, z największą częstością występowania w południowo-wschodniej części kontynentu.¹² Z kolei w Azji Wschodniej rozpowszechnienie jest znacznie niższe i wynosi od 2,5% do 8%, podczas gdy w Azji Południowo-Wschodniej i na Bliskim Wschodzie odsetek ten waha się od 6,3% do 33%.¹²

Dokładniejsza analiza danych pokazuje następujące rozpowszechnienie GERD w różnych regionach świata:¹²

Ameryka Północna: 18-28%
Europa: 9-26%
Azja Wschodnia: 3-8%
Bliski Wschód: 9-33%
Australia: około 12%
Ameryka Południowa: około 23%

Trendy czasowe w występowaniu zgagi i GERD

Od wczesnych do połowy lat 90. XX wieku częstość występowania objawów GERD w Stanach Zjednoczonych, Europie i regionach Azji Południowo-Wschodniej wzrosła o około 50%.¹² Ten trend wzrostowy utrzymywał się do końca lat 90., po czym zaobserwowano pewną stabilizację.¹

W Chinach na przykład, częstość występowania GERD wzrosła z 6,0% na początku XXI wieku do 10,6% obecnie, co wskazuje na istotny wzrost na przestrzeni czasu.¹ Podobne trendy wzrostowe obserwuje się w innych krajach azjatyckich, gdzie częstość występowania refluksowego zapalenia przełyku wzrosła z 3,4-5,0% przed 2000 rokiem do 4,3-15,7% po 2005 roku.¹

Szczególnie niepokojący jest wzrost liczby młodszych pacjentów z GERD. W ostatniej dekadzie zaobserwowano znaczący wzrost odsetka pacjentów z GERD w młodszym wieku, zwłaszcza w przedziale wiekowym 30-39 lat.¹²

Zgaga jako objaw – epidemiologia

Zgaga jest charakterystycznym objawem GERD, występującym u większości pacjentów z tą chorobą. Około 25% populacji doświadcza zgagi przynajmniej raz w miesiącu, podczas gdy 12% ma ten objaw co najmniej raz w tygodniu.¹ Klinicznie istotna zgaga dotyka około 6% populacji amerykańskiej.¹

W badaniu przeprowadzonym w Brazylii globalne rozpowszechnienie zgagi wynosiło 11,9%, przy czym 4,6% respondentów doświadczało zgagi raz w tygodniu, a 7,3% miało GERD (definiowane jako zgaga występująca częściej niż raz w tygodniu).¹²

W badaniu przeprowadzonym w Iranie częstość występowania zgagi w populacji irańskiej wynosiła:¹

Codzienna zgaga: 2,46% (95% CI: 0,93-6,39%)
Tygodniowa zgaga: 9,52% (95% CI: 6,16-14,41%)
Miesięczna zgaga: 8,19% (95% CI: 2,42-24,30%)
Ogólne rozpowszechnienie: 23,20% (95% CI: 13,56-36,79%)

Interesujące jest, że mimo powszechności objawów zgagi, większość osób nie postrzega jej jako poważnego problemu medycznego i rzadko szuka pomocy lekarskiej. Badanie przeprowadzone w hrabstwie Olmsted w stanie Minnesota wykazało, że tylko 5,4% uczestników z objawami zgagi skonsultowało się z lekarzem w ciągu ostatniego roku, mimo że ich objawy były umiarkowanie nasilone i utrzymywały się przez ponad pięć lat.¹

Czynniki ryzyka zgagi i GERD

Zidentyfikowano szereg czynników ryzyka związanych z rozwojem zgagi i GERD:¹²³

Wiek – częstość występowania GERD rośnie wraz z wiekiem, z najwyższym rozpowszechnieniem po 55 roku życia, chociaż ostatnio obserwuje się wzrost wśród młodszych dorosłych
Płeć – niektóre badania wskazują na wyższą częstość występowania GERD u kobiet (55,9% przypadków), chociaż inne nie wykazują różnic związanych z płcią
Rasa – osoby rasy białej są bardziej narażone na powikłania GERD, takie jak nadżerkowe zapalenie przełyku, zwężenia, przełyk Barretta i gruczolakorak przełyku
Otyłość – wyższy BMI i otyłość brzuszna są silnie związane z GERD
Palenie tytoniu – istotny czynnik ryzyka GERD i jego powikłań
Stres – osoby z wysokim poziomem postrzeganego stresu są bardziej narażone na rozwój GERD
Historia rodzinna – GERD wykazuje dziedziczność na poziomie około 31-43%
Status społeczno-ekonomiczny – niższy poziom wykształcenia jest związany z wyższym ryzykiem GERD
Dieta – spożywanie określonych rodzajów pokarmów i napojów może zwiększać ryzyko GERD
Infekcja Helicobacter pylori – zmniejszona częstość występowania tej infekcji może być związana ze wzrostem częstości GERD
Ograniczona aktywność fizyczna – niski poziom aktywności fizycznej jest związany z wyższym ryzykiem GERD

Analizując różnice płciowe w występowaniu zgagi w populacji irańskiej, zaobserwowano:¹²

U mężczyzn: codzienna zgaga (2,61%), tygodniowa zgaga (5,68%), miesięczna zgaga (5,93%), ogólne rozpowszechnienie (16,54%)
U kobiet: codzienna zgaga (2,90%), tygodniowa zgaga (6,89%), miesięczna zgaga (9,90%), ogólne rozpowszechnienie (19,71%)

Istotne różnice statystyczne między płciami zaobserwowano w przypadku rozpowszechnienia tygodniowego (p=0,015), miesięcznego (p<0,001) i ogólnego (p=0,008).¹

Zgaga i GERD wśród studentów medycyny

Interesującą grupą są studenci medycyny, którzy stanowią jedną z najbardziej narażonych grup na rozwój GERD. W badaniu przeprowadzonym wśród egipskich studentów medycyny, 17,1% uczestników zgłaszało objawy GERD.¹ Wśród osób z objawami GERD, 47% zgłaszało wysoki poziom postrzeganego stresu, co było znacznie wyższe niż u osób bez objawów GERD (18,7%).¹

Badanie to wykazało, że stres, palenie tytoniu i rodzinna historia choroby były niezależnymi predyktorami GERD u studentów medycyny.¹

Powikłania zgagi i ich epidemiologia

Nieleczona zgaga i GERD mogą prowadzić do poważnych powikłań, których częstość występowania jest również przedmiotem badań epidemiologicznych.¹²

Refluksowe zapalenie przełyku

Refluksowe zapalenie przełyku (erosive esophagitis) jest jednym z najczęstszych powikłań GERD. W trzech populacyjnych badaniach pacjentów, którzy zgodzili się na endoskopię niezależnie od objawów, częstość występowania nadżerkowego zapalenia przełyku wahała się od 6,4% w Chinach do 15,5% w Szwecji.¹ Wśród osób bez objawów GERD, częstość występowania nadżerkowego zapalenia przełyku wynosiła od 6,1% w Chinach do 9,5% w Szwecji.¹

Stosunek występowania refluksowego zapalenia przełyku u mężczyzn w porównaniu do kobiet wynosi 2:1-3:1, co wskazuje na wyższe ryzyko u mężczyzn.¹

Przełyk Barretta

Przełyk Barretta jest poważnym powikłaniem GERD, zwiększającym ryzyko rozwoju gruczolakoraka przełyku. Szacuje się, że przełyk Barretta występuje u 2-5,6% populacji w Stanach Zjednoczonych.¹² Wśród pacjentów z przewlekłym lub częstym GERD, częstość występowania przełyku Barretta wynosi 5-15%.¹

Mężczyźni są 2-3 razy bardziej narażeni na rozwój przełyku Barretta niż kobiety i zazwyczaj rozwijają chorobę we wcześniejszym wieku.¹ Całkowita częstość występowania przełyku Barretta jest najwyższa u osób rasy białej (6,1%) i niższa u osób rasy czarnej (1,6%) i Latynosów (1,7%).¹

Interesujące jest, że stosunek występowania przełyku Barretta u mężczyzn w porównaniu do kobiet wynosi aż 10:1, co wskazuje na znacznie wyższe ryzyko u mężczyzn.¹

Gruczolakorak przełyku

GERD jest czynnikiem ryzyka rozwoju gruczolakoraka przełyku. Badanie przeprowadzone w trzech krajach nordyckich wykazało, że częstość występowania gruczolakoraka przełyku u pacjentów z nieerozyjną chorobą refluksową przełyku wynosiła 11,0/100 000 osobolat.¹ Co ciekawe, pacjenci z nieerozyjną chorobą refluksową przełyku wydają się mieć podobną częstość występowania gruczolakoraka przełyku jak populacja ogólna.¹²

Przełyk Barretta zwiększa ryzyko gruczolakoraka przełyku 11-40 razy w porównaniu z pacjentami bez przełyku Barretta.¹ Do 40% pacjentów z gruczolakorakiem przełyku zaprzecza jakiejkolwiek historii objawów refluksu, co wskazuje, że sama symptomatologia nie jest predyktorem przełyku Barretta ani gruczolakoraka przełyku.¹

Badanie wykorzystujące dane z badania NIH-AARP Diet and Health Study wykazało, że choroba refluksowa była związana z dwukrotnie zwiększonym ryzykiem płaskonabłonkowego raka przełyku i krtani.¹

Obciążenie ekonomiczne związane ze zgagą i GERD

GERD jest odpowiedzialny za największe bezpośrednie koszty w Stanach Zjednoczonych spośród wszystkich chorób przewodu pokarmowego, a większość tych wydatków związana jest z farmakoterapią.¹ Szacuje się, że roczne koszty związane z GERD wynoszą 9-10 miliardów dolarów w samych Stanach Zjednoczonych.¹

Według niedawnego badania dotyczącego obciążenia przewlekłymi zaburzeniami żołądkowo-jelitowymi, GERD okazał się najdroższym schorzeniem, z bezpośrednimi i pośrednimi kosztami wynoszącymi 10 miliardów dolarów rocznie.¹

W Kanadzie osoby cierpiące na objawy GERD są nieobecne w pracy przez 16% każdego roku, co przekłada się na koszty w wysokości 21 miliardów dolarów lub 1,7 miliarda godzin utraconej produktywności rocznie.¹²

Badanie dotyczące wykorzystania zasobów opieki zdrowotnej (HRU) i kosztów związanych z GERD, przełykiem Barretta i nowotworzeniem związanym z przełykiem Barretta w Stanach Zjednoczonych wykazało, że pacjenci z tymi schorzeniami generują znaczące koszty związane z hospitalizacjami i wizytami ambulatoryjnymi.¹ Wraz z progresją do bardziej zaawansowanych stadiów choroby, obserwowano znacznie wyższe wykorzystanie zasobów związanych z chorobą, przy czym związane z tym koszty były 16 razy wyższe u pacjentów z gruczolakorakiem przełyku niż u tych z niezdysplastycznym przełykiem Barretta.¹

Nadzór i badania przesiewowe w zgadze i GERD

Biorąc pod uwagę potencjalne poważne powikłania nieleczonej zgagi i GERD, kwestie nadzoru i badań przesiewowych są ważnym aspektem epidemiologicznym.¹²

Endoskopia górnego odcinka przewodu pokarmowego może być wskazana w celu wykrycia przełyku Barretta i gruczolakoraka przełyku u mężczyzn powyżej 50 roku życia, którzy mieli objawy przez ponad pięć lat, i którzy mają dodatkowe czynniki ryzyka (np. nocny refluks, przepuklinę rozworu przełykowego, podwyższony wskaźnik masy ciała, używanie tytoniu, dystrybucję tłuszczu wewnątrzbrzusznego).¹

Amerykańskie Kolegium Gastroenterologii zaleca badania przesiewowe w kierunku przełyku Barretta u pacjentów z przewlekłymi objawami GERD (cotygodniowo przez 5 lat) i 3 dodatkowymi czynnikami ryzyka: płeć męska, wiek ≥50 lat, rasa biała, otyłość, palenie tytoniu, historia rodzinna przełyku Barretta lub gruczolakoraka przełyku u krewnego pierwszego stopnia.¹

Po zdiagnozowaniu przełyku Barretta, pacjentom zaleca się włączenie do programu nadzoru z regularnymi kontrolnymi badaniami endoskopowymi w celu wczesnego wykrycia zmian przedrakowych lub wczesnego raka przełyku.¹

Badania kohortowe wykazały, że górna endoskopia nie wykrywa często przełyku Barretta ani gruczolakoraka przełyku u pacjentów, u których nie wykryto tych stanów w początkowym badaniu.¹ Omawiając z pacjentami z GERD stosowanie górnej endoskopii, lekarze powinni podkreślić, że ryzyko raka przełyku u osób z zgagą jest niskie, i że pacjenci nie muszą być badani w kierunku GERD w regularnych odstępach czasu, jak w przypadku innych chorób przewlekłych.¹

Trendy w badaniach epidemiologicznych nad zgagą

Internet staje się głównym źródłem informacji związanych ze zdrowiem, co znajduje odzwierciedlenie w badaniach infodemicznych dotyczących zgagi. Analiza danych z Google Ads Keywords Planner wykazała, że liczba wyszukiwań związanych ze zgagą wzrosła w ciągu ostatnich czterech lat i może wykazywać sezonowy wzorzec w sześciu krajach zachodnich.¹²

Te obserwowane trendy w wyszukiwaniach związanych ze zgagą mogą odzwierciedlać skalę problemu i powinny być zweryfikowane w przyszłych badaniach epidemiologicznych.¹

Pojawiają się również innowacyjne podejścia do monitorowania i leczenia zgagi i GERD. Badanie BEST4 prowadzi dwie próby kliniczne mające na celu odkrycie sposobów znajdowania problemów zdrowotnych związanych ze zgagą i zapobiegania rakowi przełyku, w tym test kapsułkowej gąbki do monitorowania oznak dysplazji (zmian komórkowych poprzedzających raka) lub raka.¹

Ponadto, powstają zintegrowane centra leczenia GERD oferujące kompleksowe, wielospecjalistyczne i skoordynowane podejście skupione na pacjencie.¹ Takie podejście zespołowe, a nie indywidualne, jest prawdopodobnie optymalne dla zapewnienia optymalnej opieki i nadzoru pacjentów ze złożonym procesem chorobowym GERD.¹

Zgaga w populacjach szczególnych

Dzieci i młodzież

Refluks żołądkowo-przełykowy jest najczęściej obserwowany w okresie niemowlęcym, z pikiem w wieku 1-4 miesięcy. Może jednak występować u dzieci w każdym wieku, nawet u zdrowych nastolatków.¹

Około 85% niemowląt wymiotuje w pierwszym tygodniu życia, a 60-70% przejawia kliniczny refluks żołądkowo-przełykowy w wieku 3-4 miesięcy.¹ Szacowana częstość występowania refluksu żołądkowo-przełykowego wśród dzieci w wieku powyżej 1 roku i młodzieży waha się od 0,9% do 18,8%.¹

Niedawne badania pokazują, że GERD u niemowląt i dzieci występuje częściej niż wcześniej sądzono i może powodować powtarzające się wymioty, brak przyrostu masy ciała, kaszel i inne problemy oddechowe.¹

Kobiety ciężarne

Częstość występowania GERD zwiększa się w trakcie ciąży, dotykając 20-30% kobiet w pierwszym trymestrze, 40-45% w drugim trymestrze i 60% w trzecim trymestrze.¹

Osoby starsze

GERD występuje we wszystkich grupach wiekowych, ale jego częstość występowania zwiększa się u osób powyżej 40 roku życia.¹ Częstość występowania refluksowego zapalenia przełyku jest największa u osób w wieku 60-70 lat i nieznacznie zmniejsza się później.¹

W krajach rozwiniętych częstość występowania GERD jest ściśle powiązana z wiekiem, przy czym dorośli w wieku 60-70 lat są najczęściej dotknięci.¹

Wyzwania w badaniach epidemiologicznych nad zgagą

Badania epidemiologiczne dotyczące zgagi i GERD napotykają na szereg wyzwań. Jednym z głównych problemów jest brak złotego standardu dla diagnozowania GERD, chociaż 24-godzinne monitorowanie pH (sonda pH) jest akceptowanym standardem dla ustalenia lub wykluczenia jego obecności.¹

Określenie dokładnej częstości występowania niepowodzenia leczenia inhibitorami pompy protonowej (PPI) jest trudne, ponieważ definicje utrzymujących się objawów są różne.¹ W systematycznym przeglądzie badań przeprowadzonych w podstawowej opiece zdrowotnej (głównie w krajach europejskich i USA), wskaźniki częściowej odpowiedzi lub braku odpowiedzi na PPI (definiowane jako uciążliwa zgaga lub regurgitacja) wahały się od 17% do 32% w badaniach interwencyjnych, ale sięgały nawet 45% w badaniach obserwacyjnych.¹

W badaniu populacyjnym przeprowadzonym w USA w 2020 roku, spośród 3229 uczestników przyjmujących codziennie PPI, 54,1% miało utrzymujące się objawy GERD.¹ Ta utrzymująca się zgaga i objawy GERD pomimo leczenia stanowią istotne wyzwanie kliniczne i epidemiologiczne.

Wnioski z badań epidemiologicznych nad zgagą

Badania epidemiologiczne nad zgagą i GERD dostarczają cennych informacji dla praktyki klinicznej i polityki zdrowia publicznego:¹²

Rosnący problem zdrowotny – GERD jest coraz częstszym schorzeniem na całym świecie, z wyraźnymi różnicami geograficznymi
Zróżnicowanie geograficzne – najwyższe rozpowszechnienie obserwuje się w krajach zachodnich, szczególnie w Ameryce Północnej
Zmiany demograficzne – wzrost częstości występowania wśród młodszych pacjentów, zwłaszcza w przedziale wiekowym 30-39 lat
Związek z czynnikami stylu życia – otyłość, dieta, palenie tytoniu i stres są kluczowymi modyfikowalnymi czynnikami ryzyka
Znaczące obciążenie ekonomiczne – GERD generuje wysokie koszty bezpośrednie i pośrednie dla systemów opieki zdrowotnej
Potrzeba badań przesiewowych – u wybranych pacjentów z wysokim ryzykiem rozwoju przełyku Barretta i raka przełyku
Leczenie oparte na dowodach – skuteczne leczenie wymaga zrozumienia epidemiologii i czynników ryzyka GERD

Zrozumienie epidemiologii zgagi i GERD pomaga w identyfikacji populacji zagrożonych i wdrażaniu skutecznych strategii profilaktyki i leczenia. Biorąc pod uwagę rosnącą częstość występowania i znaczące obciążenie ekonomiczne, GERD będzie nadal stanowić istotne wyzwanie dla systemów opieki zdrowotnej na całym świecie.¹

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Materiały źródłowe

#1 Epidemiology, Causes, and Management of Gastro-esophageal Reflux Disease: A Systematic Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10658748/
GERD is a common gastrointestinal disorder, affecting around 20% of adults in Western cultures. The prevalence in the US ranges from 18.1% to 27.8%, with a slightly higher rate in men. […] GERD is a prevalent condition with no strong association with symptoms. Demographic factors such as obesity and tobacco use are strongly associated with symptoms and complications. […] GERD is a frequent digestive illness around the world, with a prevalence range of 18.1%-27.8% in North America. It is characterized by symptoms and complications resulting from stomach contents refluxing into the esophagus. […] With regional fluctuation, the overall frequency of GERD symptoms is roughly 13%. With nearly 25%, South Asia and Southeast Europe have the highest incidence, whereas the lowest is found in the Southeast Asian region, Canada, and France.
#1 Epidemiology of Gastroesophageal Reflux Disease in Asia: A Systematic Review
https://www.jnmjournal.org/view.html?uid=385&vmd=Full
Epidemiology of Gastroesophageal Reflux Disease in Asia: A Systematic Review […] From the population-based studies, the prevalence of symptom-based GERD in Eastern Asia was found to be 2.5%-4.8% before 2005 and 5.2%-8.5% from 2005 to 2010. […] In Southeast and Western Asia, it was 6.3%-18.3% after 2005, which was much higher than those in Eastern Asia. […] There were robust epidemiologic data of endoscopic reflux esophagitis in medical check-up participants. The prevalence of endoscopic reflux esophagitis in Eastern Asia increased from 3.4%-5.0% before 2000, to 4.3%-15.7% after 2005. […] In summary, the prevalence of symptom-based GERD and endoscopic reflux esophagitis has increased in Asian countries. […] During the recent decade, several studies about prevalence of symptom-based GERD and endoscopic reflux esophagitis have revealed generally higher number of patients compared to other previous Asian studies.
#1 The Prevalence and Impact of Gastroesophageal Reflux Disease – About GERD
https://aboutgerd.org/what-is/prevalence/
Over the past several years, healthcare professionals have become increasingly interested in gastroesophageal reflux disease (GERD) because of its prevalence and impact on the community. […] Studies suggest that approximately one-third of the population has GERD, according to the American Gastroenterological Association. […] A review study published in the journal Gut reports the following range of GERD prevalence estimates in global populations: 18 to 28% North America 9 to 26% Europe 3 to 8% East Asia 9 to 33% Middle East 12% Australia 23% South America. […] Since GERD is a chronic disease instead of an acute illness, it causes significant economic impact due to the expense of the long-term management of the disease. […] According to a recent study on the burden of chronic gastrointestinal disorders, GERD was found to be the most expensive, with direct and indirect costs totaling $10 billion per year.
#1 Presentation and Epidemiology of Gastroesophageal Reflux Disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC5797499/
The pooled prevalence of at least weekly GERD symptoms reported from population-based studies worldwide is approximately 13%, but there is considerable geographic variation. […] In the US, estimates of the prevalence of GERD symptoms have ranged from 6% to 30%, with heterogeneity related to the particular questionnaire used, including the threshold frequency and duration of symptoms required to be classified as GERD. […] The prevalence of at least weekly GERD symptoms in the US is approximately 20%. […] Importantly, the prevalence of GERD symptoms in North America, Europe, and Southeast Asia has increased approximately 50% relative to the baseline prevalence in the early to middle 1990s, but has plateaued since then. […] The predominant complications of GERD include dysphagia (including from peptic strictures, Schatzkis rings), bleeding from erosive esophagitis, and esophageal adenocarcinoma.
#1 Epidemiology of gastroesophageal reflux disease | WHO FCTC
https://portal-uat.who.int/fctcapps/fctcapps/fctc/kh/wts/wts-database/epidemiology-gastroesophageal-reflux-disease
The prevalence of gastroesophageal reflux disease (GERD) symptoms increased approximately 50% until the mid-1990s, when it plateaued. […] The incidence of complications related to GERD including hospitalization, esophageal strictures, esophageal adenocarcinoma, and mortality also increased during that time period, but the increase in esophageal adenocarcinoma has since slowed, and the incidence of strictures has decreased since the mid-1990s. […] GERD is responsible for the greatest direct costs in the United States of any gastrointestinal disease, and most of those expenditures are for pharmacotherapy. […] Risk factors for GERD include obesity, poor diet, lack of physical activity, consumption of tobacco and alcohol, and respiratory diseases.
#1 Meta-analysis on the epidemiology of gastroesophageal reï¬ux disease in China
https://www.wjgnet.com/1007-9327/full/v28/i45/6410.htm
Meta-analysis on the epidemiology of gastroesophageal reflux disease in China. The overall pooled prevalence of GERD was 8.7% (95%CI: 7.5%-9.9%) in mainland China. Over the past two decades, the prevalence of GERD in China has increased from 6.0% to 10.6%. GERD was more common in people aged 40-60, with body mass index 24, and of Uygur ethnicity. The prevalence was higher in the west and east than in the centre, and there may be a local spatial autocorrelation between the Qinghai-Tibet Plateau and the southeast. GERD was correlated with gastric (r= 0.421,P = 0.041) and oesophageal tumours (r= 0.511,P = 0.011) in spatial distribution. […] The prevalence of GERD in China is rising. From 6.0% at the beginning of the 21st century to 10.6% at present, there was a significant difference in the prevalence among different periods (P= 0.019). […] The prevalence rate of GERD was higher in people who were over 40 years old, obese and of the Uygur population. The prevalence of GERD was positively correlated with that of oesophageal cancer in terms of spatial distribution.
#1 The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm18140
Gastroesophageal reflux disease (GERD) is a common disease globally with increasing prevalence and consequently greater burden on the Healthcare system. […] Over the last decade, there has been a significant increase in the proportion of younger patients with GERD, especially those within the age range of 30-39 years. […] The increase in GERD prevalence may be due to multiple factors such as older age, male sex, race, intake of analgesics, consumption of certain types of food and drinks, decrease in the prevalence of Helicobacter pylori infection, smoking, family history of GERD, high body mass index (BMI), and limited physical activity. […] As risk factors for GERD increasingly affect the general population, concerns have been raised that more young individuals will develop GERD and its potential consequences.
#1 Heartburn – Wikipedia
https://en.wikipedia.org/wiki/Heartburn
About 25% of people experience heartburn at least once a month, while 12% have it at least once a week. Clinically significant heartburn affects about 6% of the American population. Most people do not see heartburn as a serious medical issue and rarely seek medical help for it. A survey in Olmsted County, Minnesota, found that only 5.4% of participants with heartburn had addressed their heartburn with a doctor in the past year, even though their symptoms were moderately severe and had lasted for over five years.
#1 SciELO Brazil – Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population
https://www.scielo.br/j/ag/a/BxRthvtJVQnzFrKXH57HH6P/?lang=en
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. […] A national inquire enrolling 13,959 adults was conducted in 22 Brazilian cities. […] 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 occurrence of GERD increased with age and was more prevalent after 55 years old. […] 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.
#1 Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01417-6
The daily, weekly, monthly, and overall prevalence of heartburn in Iranian population was 2.46% (95% CI: 0.936.39%; N=18,774), 9.52% (95% CI: 6.1614.41%; N=54,125), 8.19% (95% CI: 2.4224.30%; N=19,363) and 23.20% (95% CI: 13.5636.79%; N=26,543), respectively. […] The sensitivity analysis for prevalence of all types heartburn symptoms by removing a study showed that the overall estimate is still robust. […] For the daily prevalence of heartburn, the subgroup analysis of the area (P 0.001), study population (P 0.001), the quality of studies (P 0.001) and method of data collection (P = 0.007) were significant. […] The daily, weekly, monthly, and overall prevalence of heartburn in Iranian males was 2.61% (95% CI: 0.5910.75%; heterogeneity: I2 =98.19%, P0.001; N=4778), 5.68% (95% CI: 1.8116.44%; heterogeneity: I2 =98.69%, P0.001; N=7257), 5.93% (95% CI: 3.938.84%; heterogeneity: I2 =89.65%, P0.001; N=4788) and 16.54% (95% CI: 10.924.28%; heterogeneity: I2 =96.43%, P0.001; N=1788).
#1 Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01417-6
The daily, weekly, monthly, and overall prevalence of heartburn in Iranian females was 2.90% (95% CI: 0.3619.95%; heterogeneity: I2 =98.45%, P0.001; N=2803), 6.89% (95% CI: 2.9615.21%; heterogeneity: I2 =98.02%, P0.001; N=5171), 9.90% (95% CI: 6.4514.90%; heterogeneity: I2 =92.19%, P0.001; N=3183), 19.71% (95% CI: 11.8930.89%; heterogeneity: I2 =98.02%, P0.001; N=2803). […] OR for the prevalence of daily, weekly, monthly, and overall prevalence of heartburn in women compared to men in Table 3 shows that there is a significant difference in the weekly (P =0.015), monthly (P 0.001) and overall (P=0.008) prevalence of heartburn.
#1 Prevalence of gastro-oesophageal reflux disease, and its associated risk factors among medical students: a nation-based cross-sectional study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-02899-w
Gastroesophageal reflux disease (GERD) is a common digestive problem in adults particularly medical students, who are one of the most vulnerable groups. […] Overall, 17.1% of participants reported symptoms of GERD. […] GERD is a frequent condition among Egyptian medical students, affecting around one-fifth of them. […] The prevalence of gastroesophageal reflux disease (GERD) was found to be 17.4% (n=168) among study participants. […] Of those with GERD symptoms, 47% reported high perceived stress which is significantly higher than those without GERD symptoms (18.7%). […] In the current study, 23.7% of medical students experienced high levels of perceived stress, and participants who experienced high levels of perceived stress were more likely to develop GERD. […] This study revealed that GERD family history is significantly associated with GERD and is an independent predictor of it. […] Stress, smoking, and family history were independent predictors of GERD.
#1 Presentation and Epidemiology of Gastroesophageal Reflux Disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC5797499/
In 3 population-based studies of patients agreeing to undergo endoscopy regardless of symptoms, the prevalence of erosive esophagitis ranged from 6.4% in China to 15.5% in Sweden. […] Among individuals without symptoms of GERD, the prevalence of erosive esophagitis ranged from 6.1% in China to 9.5% in Sweden. […] There are a number of well-recognized risk factors for GERD and its complications. […] Advancing age has been inconsistently associated with an increased risk for GERD symptoms. […] However, advancing age is more strongly associated with complications of GERD. […] In the US, there appears to be similar prevalence of GERD symptoms among different races. […] However, whites are at greater risk for erosive esophagitis, strictures, Barretts esophagus, and esophageal adenocarcinoma.
#1 Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/176595-overview
Western dietary habits have made GERD a common disease. The prevalence of GERD in Western populations is estimated to be 10-20%, whereas it is about 2.5-17.0% in Asian populations. […] Richter and associates reported that 25%-40% of Americans experience symptomatic GERD at some point. Approximately 7%-10% of Americans experience symptoms of GERD on a daily basis. Because many individuals control their symptoms with over-the-counter (OTC) medications and without consulting a medical professional, the actual number of individuals with GERD is probably higher. […] No sexual predilection exists: GERD is as common in men as in women. However, the male-to-female incidence ratio for esophagitis is 2:1-3:1. The male-to-female incidence ratio for Barrett esophagus is 10:1. White males are at a greater risk for Barrett esophagus and adenocarcinoma than other populations. […] GERD occurs in all age groups. The prevalence of GERD increases in people older than 40 years.
#1 Barrett’s Esophagus | Boston Medical Center
https://www.bmc.org/gastroenterology/barretts-esophagus
BE is estimated to occur in 2 5.6 % of people in the United States. […] When patients are diagnosed with BE, they are advised to enter a surveillance program of repeat endoscopies on a regular schedule to look for precancerous dysplastic changes or early esophageal cancer. […] BE increase the risk of esophageal adenocarcinoma by 11-40 times when compared to patients without BE.
#1 Disease Management: Screening, Surveillance, and Endoscopic Management of Barrett Esophagus and Early Esophageal Cancer
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/barrett-esophagus-early-esophageal-cancer/
In the United States, it is estimated that 2% to 5% of the general population has BE. For patients with chronic or frequent GERD, the prevalence is 5% to 15%. Men are at 2 to 3 times higher risk of BE than women and tend to develop disease earlier in life. Overall, the median age at diagnosis is 50 to 60, although BE may be diagnosed in younger patients as well. The prevalence of Barrett esophagus is highest in whites (6.1%) and lower in blacks (1.6%) and Hispanics (1.7%) with a similar higher risk for men than women across races. […] Nearly half the population in the United States reports heartburn, however most never develop BE. It has been suggested that reflux symptoms experienced weekly or more frequently over the course of 5 years or more can induce metaplastic changes. Patients diagnosed with reflux at a young age are at risk for increased acid exposure over their lifetime. A case series of Veterans Affairs patients found that those with weekly GERD symptoms before age 30 were 15 times more likely to develop BE. Of note, symptom severity in GERD does not correlate with degree of acid exposure and subsequent development of BE. Half of patients with BE do not report heartburn symptoms prior to diagnosis, known as silent acid reflux. Additionally, the presence of hiatal hernia has been identified as an independent risk factor for BE. As the stomach herniates through the diaphragmatic hiatus, it pushes the gastroesophageal junction upwards and creates a straight path for entry of gastric refluxate into the distal esophagus. Patients with hiatal hernia are 4 times more likely to have long segments of BE.
#1 Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study | The BMJ
https://www.bmj.com/content/382/bmj-2023-076017
Objective To assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive gastro-oesophageal reflux disease compared with the general population. […] The incidence rate of oesophageal adenocarcinoma in patients with non-erosive gastro-oesophageal reflux disease was 11.0/100000 person-years. […] Patients with non-erosive gastro-oesophageal reflux disease seem to have a similar incidence of oesophageal adenocarcinoma as the general population. This finding suggests that endoscopically confirmed non-erosive gastro-oesophageal reflux disease does not require additional endoscopic monitoring for oesophageal adenocarcinoma. […] This study found no increased incidence of oesophageal adenocarcinoma in patients with non-erosive GORD, even after a long observation time, compared with the corresponding general population.
#1 Disease Management: Screening, Surveillance, and Endoscopic Management of Barrett Esophagus and Early Esophageal Cancer
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/barrett-esophagus-early-esophageal-cancer/
Smoking has been associated with BE in the majority of the clinical studies conducted so far. This relationship is likely due to relaxation of the lower esophageal sphincter induced by nicotine. In a pooled analysis of 5 case-control studies, patients with BE were found to be 70% more likely to have ever smoked. BE was twice as common in smokers, with the risk accruing up to 20 pack years, after which there was a plateau. […] Up to 40% of patients with EAC deny any history of reflux symptoms. This indicates that symptomatology alone is not predictive of BE or EAC. Factors such as demographics, lifestyle, and family history further stratify patients into high- and low-risk populations to aid in decision making. Although EGD is currently the gold standard for screening, it is an expensive and invasive procedure that carries small risk of complications related to sedation and the procedure itself. Physicians may be reluctant to refer patients for invasive endoscopy in the setting of controlled or absent reflux. Despite screening efforts, BE remains underdiagnosed, as fewer than 10 % of patients with EAC carry a prior diagnosis of BE. Current research is focused on creating risk prediction models and efficient and cost-effective screening methods via alternative modalities.
#1 Acid Reflux Disease and Cancer Risk – NCI
https://dceg.cancer.gov/news-events/news/2021/gerd-cancer-risk
Using data from the NIH-AARP Diet and Health Study, Christian C. Abnet, Ph.D. M.P.H., Chief of the Metabolic Epidemiology Branch, and colleagues, found that acid reflux disease was associated with a two-fold increased risk of esophageal and laryngeal squamous cell carcinomas. […] The results of this study illuminate the association of GERD and risk of laryngeal and esophageal squamous cell carcinomas. […] Future studies are needed to replicate these findings and to establish GERD as a risk factor for these cancers and other diseases.
#1 Modern diagnosis of GERD: the Lyon Consensus | Gut
https://gut.bmj.com/content/67/7/1351
GERD has an estimated worldwide prevalence of 8%33%, involves all age groups and both genders1 and carries a price tag estimated at US$9US$10billion/year in the USA alone, largely related to proton pump inhibitors (PPI) use and diagnostic testing.2 […] The aim of the GERD consensus process was to determine modern indications for oesophageal testing in GERD, and as an extension to that aim, to define criteria for a clinical diagnosis of GERD. […] The Lyon Consensus evaluated GERD diagnostic tests from that perspective, and test results were categorised as being adequate to establish or refute a GERD diagnosis or inconclusive in the absence of additional supportive evidence. […] The primary focus of oesophageal testing has hitherto been restricted to detection of excessive acid reflux as indicative of pathological GERD, supported by reflux-symptom association analysis.
#1 GERD – Canadian Digestive Health Foundation
https://cdhf.ca/en/digestive-conditions/gerd/
GERD is a common disorder that has a significant impact on the community. In Canada, people suffering from GERD symptoms are absent from work 16% of each year, representing $21 billion in costs or 1.7 billion hours of lost productivity annually. […] Recent studies show that GERD in infants and children occurs more frequently than previously thought and may produce repeated vomiting, failure to grow, coughing and other respiratory problems. […] Some patients with prolonged, uncontrolled GERD may develop Barrettâs esophagus, a condition that results in changes to the esophageal lining which increase the risk of developing esophageal cancer. […] GERD symptoms are widespread in the community and range from 2.5% to more than 25%. (Savarino et al. 2017) […] In North America, it is estimated that the prevalence of GERD is 15%. (Eusebi et al. 2018)
#1 Healthcare Resource Utilization and Costs Among Patients With Gastroesophageal Reflux Disease, Barrettâs Esophagus, and Barrettâs Esophagus-Related Neoplasia in the United States | Published in Journal of Health Economics and Outcomes Research
https://jheor.org/article/68191-healthcare-resource-utilization-and-costs-among-patients-with-gastroesophageal-reflux-disease-barrett-s-esophagus-and-barrett-s-esophagus-related-ne
Gastroesophageal reflux disease (GERD) is a risk factor for Barretts esophagus (BE) and BE-related neoplasia (BERN). […] This study aimed to evaluate healthcare resource utilization (HRU) and costs associated with GERD, BE, and BERN in the United States. […] Patients with GERD, BE, and BERN had important HRU and costs, including inpatient admissions and office visits. […] As patients progressed to more advanced stages, there was substantially higher disease-related resource utilization, with associated costs being 16 times higher in patients with EAC than those with NDBE. […] Findings suggest the need for early identification of high-risk individuals prior to progression to EAC to potentially improve clinical and economic outcomes in this population. […] The burden associated with esophageal disorders has been well characterized in the United States, with healthcare expenditures exceeding $12 billion in 2018.
#1
https://best4trial.org/
BEST4 is running two trials to discover ways to find heartburn-related health problems and prevent oesophageal cancer. […] The BEST4 Surveillance Trial is for people who already have a diagnosis of Barretts Oesophagus aiming to see if the capsule sponge test can be used for monitoring of any signs of dysplasia (cell changes prior to cancer) or cancer.
#1 ACP Publishes Recommendations on Upper Endoscopy for Gastroesophageal Reflux Disease | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1215/p865.html
Upper endoscopy may be indicated to detect Barrett esophagus and esophageal adenocarcinoma in men older than 50 years who have had symptoms for more than five years, and who have additional risk factors (e.g., nocturnal reflux, hiatal hernia, elevated body mass index, tobacco use, intra-abdominal body fat distribution). […] Multiple cohort studies have shown that upper endoscopy does not often detect Barrett esophagus or esophageal adenocarcinoma in patients who are not found to have these conditions on initial examination. […] When discussing the use of upper endoscopy with patients who have GERD, physicians should emphasize that the risk of esophageal cancer in persons with heartburn is low, and that patients do not need to be evaluated for GERD at regular intervals as they do for other chronic diseases.
#1 Gastroesophageal reflux disease – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/gastroesophageal-reflux-disease/
Prevalence: 15-30% in the US (increases with age) […] Epidemiological data refers to the US, unless otherwise specified. […] Endoscopic examination of the esophagus is indicated to screen for Barrett esophagus in patients with chronic GERD symptoms (weekly for 5 years) and 3 additional risk factors: male sex, age 50 years, White race, obesity, smoking, family history of Barrett esophagus or esophageal adenocarcinoma in a first-degree relative.
#1 Heartburn-Related Internet Searches and Trends of Interest across Six Western Countries: A Four-Year Retrospective Analysis Using Google Ads Keyword Planner
https://www.mdpi.com/1660-4601/16/23/4591
The internet is becoming the main source of health-related information. We aimed to investigate data regarding heartburn-related searches made by Google users from Australia, Canada, Germany, Poland, the United Kingdom, and the United States. We retrospectively analyzed data from Google Ads Keywords Planner. […] The trends in heartburn-related searches may reflect the scale of the complaint, and should be verified through future epidemiological studies. […] In this infodemiology study, we found that the number of heartburn-related searches has increased over the last four years and may present a seasonal pattern in six Western countries. […] To the best of our knowledge, this is the first infodemiology study to use Google Ads to assess Internet usersâ interest in heartburn-related information.
#1 Heartburn-Related Internet Searches and Trends of Interest across Six Western Countries: A Four-Year Retrospective Analysis Using Google Ads Keyword Planner
https://www.mdpi.com/1660-4601/16/23/4591
Our data showed that Google users from DE are particularly interested in the treatment of heartburn. […] In all analyzed countries except DE, we observed, over the period examined, a significant growth in the number of queries associated with heartburn. […] The observed trends in heartburn-related searches may reflect the scale of the complaint, and should be verified through future epidemiological studies.
#1 Frontiers | Heartburn Center Set-Up in a Community Setting: Engineering and Execution
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.662007/full
Background: Optimal management of gastroesophageal reflux disease (GERD) requires a concerted team of physicians rather than an individual approach. […] Ranging from initial consultation and diagnosis to surgical intervention for complex disease, such an approach is likely to provide optimal care and provide surveillance for patients with a complex disease process of GERD. […] Conclusions: While centralization of GERD care is known to improve outcomes, in this case study we demonstrated the clinical success and commercial viability of centralizing GERD care in a community setting. […] The integrated GERD service line center offered a comprehensive, multi-specialty, and coordinated patient-centered approach.
#1 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology
https://emedicine.medscape.com/article/930029-overview
Gastroesophageal reflux is most commonly seen in infancy, with a peak at age 1-4 months. However, it can be seen in children of all ages, even healthy teenagers. […] Approximately 85% of infants vomit during the first week of life, and 60-70% manifest clinical gastroesophageal reflux at age 3-4 months. […] The estimated prevalence of gastroesophageal reflux among children aged older than 1 year and adolescents ranges from 0.9-18.8%.
#1 Gastroesophageal Reflux Disease (GERD) | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/28304
Geographical variations are present in the distribution of the diagnosis of GERD. In Western countries, the prevalence of the disease is approximately 10% to 20%, and severe disease is observed in 6% of the population. In Asian countries, the prevalence is approximately 5%. […] The incidence of reflux esophagitis is greatest in individuals aged 60 to 70 and slightly decreases thereafter. Similar to its prevalence in adults, GERD is also increasingly observed in the pediatric population. Nelson et al reported an incidence of GERD ranging from 12% to 50% in children aged 0 to 18 between 2000 and 2005. […] The prevalence of GERD increases throughout pregnancy, affecting 20% to 30% of women in the first trimester, 40% to 45% in the second trimester, and 60% in the third trimester. […] The association of GERD with overweight patients has an odds ratio of 1.33 and 95% confidence intervals of 1.07 to 1.64; the association with obese individuals has an odds ratio of 1.70 and a 95% confidence interval of 1.36 to 2.12. […] Several medications have been associated with symptoms of GERD, including drugs that modulate the lower esophageal sphincter pressure, including nitrates, calcium channel blocker agents, anticholinergics, -adrenergic agonists, theophylline, and morphine.
#1 Gastroesophageal reflux disease – Wikipedia
https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease
In Western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. […] For instance, an estimated 3.4 million to 6.8 million Canadians have GERD. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 60 to 70 being the most commonly affected. […] In the United States 20% of people have symptoms in a given week and 7% every day. […] No data supports sex predominance with regard to GERD.
#1 Management of Gastroesophageal Reflux Disease | AAFP
https://www.aafp.org/pubs/afp/issues/2003/1001/p1311.html
A careful history is essential to establish the diagnosis of GERD. If a patient has classic symptoms of heartburn and acid regurgitation, the diagnosis can be made with high specificity, yet the sensitivity remains low. GERD can be missed in patients with heartburn, and some patients with Barrett’s esophagus or adenocarcinoma of the esophagus do not complain of heartburn. […] There is no gold standard for diagnosing GERD, although 24-hour pH monitoring (pH probe) is the accepted standard for establishing or excluding its presence. […] Further diagnostic testing should be performed in patients who have not responded to continuous therapy or who require such treatment, exhibit warning symptoms, or have risk factors for Barrett’s esophagus.
#1 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine
https://www.nature.com/articles/s43856-024-00632-6
Persistent GERD symptoms are associated with anxiety, decreased quality of life, and decreased ability to work. […] It is estimated that the prevalence of GERD is 8.8-25.9% in Europe and 18.1-27.8% in North America. […] Determining the exact prevalence of PPI failure is challenging since definitions of persistent symptoms vary. […] Controlled studies with PPIs frequently report heartburn as the primary outcome measure. […] In a systematic review of studies set in primary care (mainly European countries and the USA), rates of partial response or nonresponse to PPIs (defined as troublesome heartburn or regurgitation) ranged from 17 to 32% in interventional studies but were as high as 45% in observational studies. […] In a USA population-based study from 2020, of the 3229 participants taking daily PPIs, 54.1% had persistent GERD symptoms.
#1 Epidemiology, Causes, and Management of Gastro-esophageal Reflux Disease: A Systematic Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10658748/
In the US, the rate of GERD symptoms is over 20%, with 110,000 hospitalizations each year. Since the early to mid-1990s, the frequency of symptoms of GERD in the US, Europe, and Southeast Asian regions has grown by 50%. […] GERD patients must be evaluated for alarm features, prompting urgent endoscopic evaluation. If no warning symptoms are present, the first treatment should focus on lifestyle modification. […] GERD is typically managed through PPI therapy and lifestyle changes. […] GERD is a prevalent disease in the Western world, affecting 10%-20% of the population. Symptoms include acid regurgitation and heartburn, with high specificity for GERD. […] GERD is a prevalent, chronic disorder with limited knowledge and changing management. Recent advances in disease etiology and novel medications have aided in overcoming traditional therapy’s unmet needs. […] In the US, the rising obesity epidemic is correlated with an increased prevalence of GERD.
#1 GERD – Epidemiology
https://epidemiology.blog/about/index/gerd
Gastroesophageal reflux disease, commonly known as GERD, is a chronic condition where stomach contents flow back into the esophagus, causing symptoms such as heartburn, regurgitation, and discomfort. Understanding the epidemiology of GERD is crucial for identifying its prevalence, risk factors, and the burden it imposes on public health. […] The prevalence of GERD varies widely across different regions and populations. In Western countries, it is estimated that about 10-20% of the population experiences GERD symptoms weekly. In contrast, the prevalence is lower in Asian countries, ranging from 2-8%. The incidence rate, which measures the number of new cases over a specific period, also varies but tends to be higher in populations with Westernized diets and lifestyles. […] GERD imposes a substantial burden on healthcare systems worldwide. The direct costs include medical consultations, diagnostic tests, and medications, while the indirect costs involve lost productivity and absenteeism. Public health strategies should focus on lifestyle modifications, early diagnosis, and effective management to reduce this burden. […] Understanding its epidemiology helps in identifying at-risk populations and implementing effective prevention and management strategies.
#2 The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm18140
Gastroesophageal reflux disease (GERD) is a common disease globally with increasing prevalence and consequently greater burden on the Healthcare system. […] Over the last decade, there has been a significant increase in the proportion of younger patients with GERD, especially those within the age range of 30-39 years. […] The increase in GERD prevalence may be due to multiple factors such as older age, male sex, race, intake of analgesics, consumption of certain types of food and drinks, decrease in the prevalence of Helicobacter pylori infection, smoking, family history of GERD, high body mass index (BMI), and limited physical activity. […] As risk factors for GERD increasingly affect the general population, concerns have been raised that more young individuals will develop GERD and its potential consequences.
#2 Presentation and Epidemiology of Gastroesophageal Reflux Disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC5797499/
The pooled prevalence of at least weekly GERD symptoms reported from population-based studies worldwide is approximately 13%, but there is considerable geographic variation. […] In the US, estimates of the prevalence of GERD symptoms have ranged from 6% to 30%, with heterogeneity related to the particular questionnaire used, including the threshold frequency and duration of symptoms required to be classified as GERD. […] The prevalence of at least weekly GERD symptoms in the US is approximately 20%. […] Importantly, the prevalence of GERD symptoms in North America, Europe, and Southeast Asia has increased approximately 50% relative to the baseline prevalence in the early to middle 1990s, but has plateaued since then. […] The predominant complications of GERD include dysphagia (including from peptic strictures, Schatzkis rings), bleeding from erosive esophagitis, and esophageal adenocarcinoma.
#2 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine
https://www.nature.com/articles/s43856-024-00632-6
Persistent GERD symptoms are associated with anxiety, decreased quality of life, and decreased ability to work. […] It is estimated that the prevalence of GERD is 8.8-25.9% in Europe and 18.1-27.8% in North America. […] Determining the exact prevalence of PPI failure is challenging since definitions of persistent symptoms vary. […] Controlled studies with PPIs frequently report heartburn as the primary outcome measure. […] In a systematic review of studies set in primary care (mainly European countries and the USA), rates of partial response or nonresponse to PPIs (defined as troublesome heartburn or regurgitation) ranged from 17 to 32% in interventional studies but were as high as 45% in observational studies. […] In a USA population-based study from 2020, of the 3229 participants taking daily PPIs, 54.1% had persistent GERD symptoms.
#2 Epidemiology of Gastroesophageal Reflux Disease in Asia: A Systematic Review
https://www.jnmjournal.org/view.html?uid=385&vmd=Full
The prevalence of GERD in Iran was 6.3%-18.3% from 2005 to 2010, which seemed more prevalent than in Eastern Asia. […] The prevalence in Western Asia was found to be the highest among the whole Asian region as represented by 20% in Turkey. […] The prevalence of endoscopic reflux esophagitis in Eastern Asia was 3.4%-5.0% before 2000, with these 2 studies using the definition of reflux esophagitis by Savary-Miller classification, while other 9 studies showed results of 6.6%-15.0% from 2000 to 2005 and 4.3%-15.7% after 2005, with the definition by LA classification. […] The prevalence of GERD showed wide range results as followings: 12.4%-31.7% of symptom-based GERD, 2.3%-14.7% of NERD and 7.1%-20.8% of endoscopic reflux esophagitis. […] The prevalence of Barrett’s esophagus was reported as 0.06%-0.84% in medical check-up and 0.31%-2.00% in the referral hospital settings. […] The prevalence of Barrett’s esophagus was found to be relatively low.
#2 Heartburn epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Heartburn_epidemiology_and_demographics
Heartburn is a very prevalent symptom in general populations worldwide. […] In 2013, the prevalence of gastroesophageal reflux disease (GERD) was estimated to be: 18,10027,800 cases per 100,000 individuals in North America, 8,80025,900 cases per 100,000 individuals in Europe, 2,5007,800 cases per 100,000 individuals in East Asia, 8,70033,100 cases per 100,000 individuals in the Middle East, 11,600 cases per 100,000 individuals in Australia, 23,000 cases per 100,000 individuals in South America.
#2 Epidemiology of gastroesophageal reflux disease | WHO FCTC
https://portal-uat.who.int/fctcapps/fctcapps/fctc/kh/wts/wts-database/epidemiology-gastroesophageal-reflux-disease
The prevalence of gastroesophageal reflux disease (GERD) symptoms increased approximately 50% until the mid-1990s, when it plateaued. […] The incidence of complications related to GERD including hospitalization, esophageal strictures, esophageal adenocarcinoma, and mortality also increased during that time period, but the increase in esophageal adenocarcinoma has since slowed, and the incidence of strictures has decreased since the mid-1990s. […] GERD is responsible for the greatest direct costs in the United States of any gastrointestinal disease, and most of those expenditures are for pharmacotherapy. […] Risk factors for GERD include obesity, poor diet, lack of physical activity, consumption of tobacco and alcohol, and respiratory diseases.
#2 The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?
https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm18140
Our study showed that the proportion of patients with GERD has increased in all age groups, with the exception of those who were aged 70 years in both the universal and Healthcare system datasets. […] In our study, however, the greatest rise in the proportion of patients with GERD diagnosis was seen in young adults aged 30-39 years in both datasets during the last decade. […] An important finding of our study was the general characteristic of GERD patients who were primarily obese or severely obese, older women, and Caucasian. […] Our study suggests that physicians should be more aware that the proportion of young adults with GERD has been increasing continuously.
#2 SciELO Brazil – Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population
https://www.scielo.br/j/ag/a/BxRthvtJVQnzFrKXH57HH6P/?lang=en
The global prevalence of heartburn was 11.9%, the prevalence of heartburn occurring only once a week was 4.6% and the prevalence of GERD (heartburn more than once a week) was 7.3%. […] The occurrence of GERD increased with age, and is more prevalent after 55 years old. […] The prevalence of women in 55.9% of the cases of GERD is noteworthy, although similar findings have been reported by LIND et al.
#2 Presentation and Epidemiology of Gastroesophageal Reflux Disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC5797499/
In 3 population-based studies of patients agreeing to undergo endoscopy regardless of symptoms, the prevalence of erosive esophagitis ranged from 6.4% in China to 15.5% in Sweden. […] Among individuals without symptoms of GERD, the prevalence of erosive esophagitis ranged from 6.1% in China to 9.5% in Sweden. […] There are a number of well-recognized risk factors for GERD and its complications. […] Advancing age has been inconsistently associated with an increased risk for GERD symptoms. […] However, advancing age is more strongly associated with complications of GERD. […] In the US, there appears to be similar prevalence of GERD symptoms among different races. […] However, whites are at greater risk for erosive esophagitis, strictures, Barretts esophagus, and esophageal adenocarcinoma.
#2 Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01417-6
The daily, weekly, monthly, and overall prevalence of heartburn in Iranian females was 2.90% (95% CI: 0.3619.95%; heterogeneity: I2 =98.45%, P0.001; N=2803), 6.89% (95% CI: 2.9615.21%; heterogeneity: I2 =98.02%, P0.001; N=5171), 9.90% (95% CI: 6.4514.90%; heterogeneity: I2 =92.19%, P0.001; N=3183), 19.71% (95% CI: 11.8930.89%; heterogeneity: I2 =98.02%, P0.001; N=2803). […] OR for the prevalence of daily, weekly, monthly, and overall prevalence of heartburn in women compared to men in Table 3 shows that there is a significant difference in the weekly (P =0.015), monthly (P 0.001) and overall (P=0.008) prevalence of heartburn.
#2 Disease Management: Screening, Surveillance, and Endoscopic Management of Barrett Esophagus and Early Esophageal Cancer
https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/barrett-esophagus-early-esophageal-cancer/
In the United States, it is estimated that 2% to 5% of the general population has BE. For patients with chronic or frequent GERD, the prevalence is 5% to 15%. Men are at 2 to 3 times higher risk of BE than women and tend to develop disease earlier in life. Overall, the median age at diagnosis is 50 to 60, although BE may be diagnosed in younger patients as well. The prevalence of Barrett esophagus is highest in whites (6.1%) and lower in blacks (1.6%) and Hispanics (1.7%) with a similar higher risk for men than women across races. […] Nearly half the population in the United States reports heartburn, however most never develop BE. It has been suggested that reflux symptoms experienced weekly or more frequently over the course of 5 years or more can induce metaplastic changes. Patients diagnosed with reflux at a young age are at risk for increased acid exposure over their lifetime. A case series of Veterans Affairs patients found that those with weekly GERD symptoms before age 30 were 15 times more likely to develop BE. Of note, symptom severity in GERD does not correlate with degree of acid exposure and subsequent development of BE. Half of patients with BE do not report heartburn symptoms prior to diagnosis, known as silent acid reflux. Additionally, the presence of hiatal hernia has been identified as an independent risk factor for BE. As the stomach herniates through the diaphragmatic hiatus, it pushes the gastroesophageal junction upwards and creates a straight path for entry of gastric refluxate into the distal esophagus. Patients with hiatal hernia are 4 times more likely to have long segments of BE.
#2 Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study | The BMJ
https://www.bmj.com/content/382/bmj-2023-076017
Patients with GORD but no oesophageal mucosal abnormalities have a similar incidence of oesophageal adenocarcinoma as the general population. […] The findings from this study may show a distinctive difference in how to manage oesophageal adenocarcinoma risk in patients with GORD. […] This finding suggests that patients with confirmed non-erosive GORD are not susceptible to develop oesophageal adenocarcinoma and may not require repeated endoscopic examinations regarding assessment of cancer risk.
#2 GERD – Canadian Digestive Health Foundation
https://cdhf.ca/en/digestive-conditions/gerd/
A Canadian study estimated that patients with GERD lose 16% of their work time due to their symptoms. (Fedorak et al. 2010) […] Communicating with your doctor is important for GERD disease management. Keeping the lines of communication open allows your healthcare professional to closely follow your symptoms and determine which steps should be taken to ensure that your GERD symptoms do not develop into Barrettâs esophagus, which is the primary risk factor for esophageal cancer. Furthermore, up to 15% of people who develop GERD will develop Barrettâs esophagus. […] In addition to its negative impact on health-related quality of life, GERD may lead to serious diseases including Barrettâs esophagus. Over a quarter of GERD patients may progress to Barrettâs esophagus in their lifetime. If untreated, Barrettâs esophagus may progress to esophageal cancer. Esophageal cancer may not be curable depending on the stage at diagnosis. It has a low five-year survival rate of 14%.
#2 ACP Publishes Recommendations on Upper Endoscopy for Gastroesophageal Reflux Disease | AAFP
https://www.aafp.org/pubs/afp/issues/2013/1215/p865.html
Upper endoscopy may be indicated to detect Barrett esophagus and esophageal adenocarcinoma in men older than 50 years who have had symptoms for more than five years, and who have additional risk factors (e.g., nocturnal reflux, hiatal hernia, elevated body mass index, tobacco use, intra-abdominal body fat distribution). […] Multiple cohort studies have shown that upper endoscopy does not often detect Barrett esophagus or esophageal adenocarcinoma in patients who are not found to have these conditions on initial examination. […] When discussing the use of upper endoscopy with patients who have GERD, physicians should emphasize that the risk of esophageal cancer in persons with heartburn is low, and that patients do not need to be evaluated for GERD at regular intervals as they do for other chronic diseases.
#2 Heartburn-Related Internet Searches and Trends of Interest across Six Western Countries: A Four-Year Retrospective Analysis Using Google Ads Keyword Planner
https://www.mdpi.com/1660-4601/16/23/4591
Our data showed that Google users from DE are particularly interested in the treatment of heartburn. […] In all analyzed countries except DE, we observed, over the period examined, a significant growth in the number of queries associated with heartburn. […] The observed trends in heartburn-related searches may reflect the scale of the complaint, and should be verified through future epidemiological studies.
#2 GERD – Epidemiology
https://epidemiology.blog/about/index/gerd
Gastroesophageal reflux disease, commonly known as GERD, is a chronic condition where stomach contents flow back into the esophagus, causing symptoms such as heartburn, regurgitation, and discomfort. Understanding the epidemiology of GERD is crucial for identifying its prevalence, risk factors, and the burden it imposes on public health. […] The prevalence of GERD varies widely across different regions and populations. In Western countries, it is estimated that about 10-20% of the population experiences GERD symptoms weekly. In contrast, the prevalence is lower in Asian countries, ranging from 2-8%. The incidence rate, which measures the number of new cases over a specific period, also varies but tends to be higher in populations with Westernized diets and lifestyles. […] GERD imposes a substantial burden on healthcare systems worldwide. The direct costs include medical consultations, diagnostic tests, and medications, while the indirect costs involve lost productivity and absenteeism. Public health strategies should focus on lifestyle modifications, early diagnosis, and effective management to reduce this burden. […] Understanding its epidemiology helps in identifying at-risk populations and implementing effective prevention and management strategies.
#3 Epidemiology of gastroesophageal reflux disease | WHO FCTC
https://portal-uat.who.int/fctcapps/fctcapps/fctc/kh/wts/wts-database/epidemiology-gastroesophageal-reflux-disease
The prevalence of gastroesophageal reflux disease (GERD) symptoms increased approximately 50% until the mid-1990s, when it plateaued. […] The incidence of complications related to GERD including hospitalization, esophageal strictures, esophageal adenocarcinoma, and mortality also increased during that time period, but the increase in esophageal adenocarcinoma has since slowed, and the incidence of strictures has decreased since the mid-1990s. […] GERD is responsible for the greatest direct costs in the United States of any gastrointestinal disease, and most of those expenditures are for pharmacotherapy. […] Risk factors for GERD include obesity, poor diet, lack of physical activity, consumption of tobacco and alcohol, and respiratory diseases.