Prevalence and Determinants of Gastroesophageal Reflux Symptoms in Adolescents

Jiann-Hwa Chen; Hsin-Yi Wang; Hans Hsienhong Lin; Chia-Chi Wang; Li-Yu Wang


J Gastroenterol Hepatol. 2014;29(2):269-275. 

In This Article

Abstract and Introduction


Background and Aims Gastroesophageal reflux disease (GERD) is common in adults, and there are increasing secular trends in adult GERD morbidity in many countries. However, population-based study on adolescent GERD was very limited. The specific aims of the study were to explore the prevalence and determinant of GERD symptoms in adolescents.

Methods A population-based association study was performed on 1828 students aged 13–16 years from four public junior high schools in Taiwan. The presences of symptoms of GERD, asthma and food allergy, demographic characteristics, and health behaviors were obtained by structured questionnaires.

Results Complete information of symptoms of GERD and asthma were available for 1745 (95.5%) students. The cumulative and 3-month prevalence rates of GERD symptoms were 20.5% and 8.9%, respectively. Multivariate-adjusted odds ratio of having experienced GERD symptoms were 1.53 (95% confidence interval [CI]: 1.18–1.98) for ever smoking, 1.52 (95% CI: 1.12–2.26) for bi-ethnicity, 1.70 (95% CI: 1.26–2.29) for food allergy, and 3.59 (95% CI: 2.69–4.82) and 2.43 (95% CI: 1.67–3.53) for having asthma attacks within or more than 1 year before, respectively. Similar results were found for 3-month prevalence.

Conclusions The study showed that GERD symptoms were frequent in junior high school students in Taiwan. Food allergy, asthma, and cigarette smoking were independently correlated with the prevalence of GERD symptoms. Psychosocial factors associated with bi-ethnic family may contribute to its development.


Gastroesophageal reflux disease (GERD) is a chronic, relapsing disorder characterized by recurrent, bothersome reflux symptoms and is diagnosed based on symptoms only.[1,2] The affected subjects had elevated risks of esophagitis, Barrett's esophagus, and ulcer and cancer of the esophagus.[3–5] GERD is common among adults;[6,7] nonetheless, significantly geographic variation in the prevalence had been reported. The prevalence rates, defined as related symptoms occurred at least weekly, in Europe and North America were 10~26% and in Asia were 2.5~12%.[8] Similar increasing secular trends were observed in several countries.[9] It is also recognized that GERD symptoms influence the quality of life.[10,11]

In addition to symptoms occur in esophagus, GERD is believed to lead to extraesophageal symptoms and complications, primarily in respiratory system.[4,12,13] Significant associations between asthma and GERD were reported by several studies.[13–15] Reflux may precipitate asthma, either via a vagal reflex initiated by gastric fluid in the esophagus, or by microaspiration of gastric contents into the trachea.[16] Conversely, asthma may promote reflux because of the increased pressure swings in the thorax during respiration.[17,18] Several studies had demonstrated significant relationships between the severities of symptoms of GERD and asthma.[19,20] However, because of the limited data, the causal relationship between GERD and asthma is not yet established.[15]

Several recent adult studies have identified several risk factors, including obesity, cigarette smoking, and nonsteroidal anti-inflammatory drugs usages.[4,21–23] GERD symptoms affect all age groups, and it is reasonable to hypothesize that pathogenesis in adolescence is similar to that of in adult; nonetheless, there was a few research on adolescent GERD. We therefore conducted the present population-based association study to assess its prevalence, to confirm its association with asthma, and to explore its determinants in adolescents.