Racial and Geographic Issues in Gastroesophageal Reflux Disease

Prateek Sharma, MD, FACP, FACG; Sachin Wani, MD; Yvonne Romero, MD; David Johnson, MD; Frank Hamilton, MD

Disclosures

Am J Gastroenterol. 2008;103(11):2669-2680. 

In This Article

Abstract and Introduction

Abstract

Gastroesophageal reflux disease (GERD) is a common chronic disorder that is associated with a huge economic burden in the western countries and significantly decreased quality of life. This review focuses on the various multicultural issues in the epidemiology, pathophysiology, diagnosis, and treatment of GERD. The prevalence of GERD appears to be highest in North America and Europe, whereas epidemiologic data from the Indian subcontinent, Africa, South America, and the Middle East are sparse. A limited number of studies have elucidated ethnic differences in GERD in multiracial populations. African Americans and Asians appear to be at a lower risk for the development of complicated GERD including Barrett's esophagus (BE). Whether the pathophysiology of GERD differs among different populations remains to be answered satisfactorily. It appears that most of the factors involved in the pathogenesis of GERD, as described in western populations, are present in Asians but at a lower scale. The current recommendations for the management of GERD by the American College of Gastroenterology may not meet the need for different ethnic groups or for different geographic regions. Recognition of language barriers in understanding the common terms used to describe reflux symptoms should be borne in mind while treating GERD patients with different ethnic backgrounds. In addition, a universally accepted definition for treatment success in GERD patients is lacking. Given the negative impact on health-related quality of life, significant cost ramifications, and increased risk for BE and esophageal adenocarcinoma, the study of multicultural issues in GERD should be considered.

Introduction

Gastroesophageal reflux disease (GERD), defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications, is a common chronic disorder prevalent in many countries.[1] It is associated with a huge economic burden in the western countries and significantly decreased quality of life.[2,3,4,5] It is the most common gastrointestinal-related diagnosis given during office visits and direct medical costs which primarily include drug costs exceed 10 billion dollars per year in the United States,[2] whereas indirect costs resulting from reduced work productivity are estimated to be as much as 75 billion dollars per year.[3] Complicated GERD includes erosive esophagitis, hemorrhage, ulcerative esophagitis, and esophageal strictures. GERD is a well established risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma, the most rapidly rising incidence of cancer in the western world.[6,7]

Traditionally, GERD has been viewed as a disease of the western world and thought to be uncommon in the developing countries. A recent systematic review identified a 10-20% prevalence of GERD (at least weekly heartburn and/or regurgitation) in the western countries; while in Asia, the prevalence was at <5%.[4] It has been suggested that there is an increasing trend in the prevalence of GERD over the last two decades[5] and that reflux disease is more common in Asian countries than previously recognized.[6] Studying racial and geographic differences in GERD and its complications are important as they highlight environmental or genetic influences in etiology and increase our understanding of the disease pathogenesis and management. This review focuses on the various multicultural issues in the epidemiology, pathophysiology, diagnosis, and treatment of GERD. Relevant studies, limited to the English language, were identified via PubMed searches (1966 to May 2007) with the search terms gastroesophageal reflux disease, gastroesophageal reflux, reflux, erosive esophagitis, BE along with prevalence, incidence, epidemiology, ethnicity, geographic differences, and risk factors. Recent reviews on the epidemiology of GERD were also examined for appropriate publications.[4,5,6] Studies on pediatric subjects were excluded.

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