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Wickramasinghe N, Devanarayana NM. Insight into global burden of gastroesophageal reflux disease: Understanding its reach and impact. World J Gastrointest Pharmacol Ther 2025; 16:97918. [PMID: 40094147 PMCID: PMC11907340 DOI: 10.4292/wjgpt.v16.i1.97918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 10/29/2024] [Accepted: 12/10/2024] [Indexed: 03/03/2025] Open
Abstract
The exact worldwide prevalence of gastroesophageal reflux disease (GERD) remains uncertain, despite its recognition as a common condition. This conundrum arises primarily from the lack of a standardized definition for GERD. The gold standard diagnostic tests for GERD, such as pH impedance testing and endoscopy, are cumbersome and impractical for assessing community prevalence. Consequently, most epidemiological studies rely on symptom-based screening tools. GERD symptoms can be both esophageal and extraesophageal, varying widely among individuals. This variability has led to multiple symptom-based definitions of GERD, with no consensus, resulting in prevalence estimates ranging from 5% to 25% worldwide. Most systematic reviews define GERD as experiencing heartburn and/or regurgitation at least once weekly, yielding a calculated prevalence of 13.98%. In 2017, the global age-standardized prevalence of GERD was estimated at 8819 per 100000 people (95% confidence interval: 7781-9863), a figure that has remained stable from 1990 to 2017. Prevalence increases with age, leading to more years lived with disability. GERD significantly impairs quality of life and can lead to multiple complications. Additionally, it imposes a severe economic burden, with the United States alone estimated to spend around 10 billion dollars annually on diagnosis and treatment. In summary, GERD prevalence varies greatly by region and even within different areas of the same province. Determining the exact prevalence is challenging due to inconsistent diagnostic criteria. However, it is well-documented that GERD poses a significant global burden, affecting the quality of life of individuals and creating a substantial healthcare cost.
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Affiliation(s)
- Nilanka Wickramasinghe
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo 00800, Western Province, Sri Lanka
| | - Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
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Shacker M, Latorre-Rodríguez AR, Mittal SK. Prevalence and severity of abdominal bloating in patients with gastroesophageal reflux disease. Dis Esophagus 2024; 37:doad058. [PMID: 37738150 DOI: 10.1093/dote/doad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
Abdominal bloating (AB) is a common symptom among patients with gastroesophageal reflux disease (GERD); however, in clinical practice, its prevalence is likely underestimated due to the lack of objective tools to measure its frequency and severity. It is associated with dissatisfaction and worse quality of life, but data on its prevalence before and after mechanical control of GERD (i.e. fundoplication, magnetic sphincter augmentation, and antireflux mucosectomy) are lacking. To assess and determine the pre- and postoperative prevalence and severity of AB among patients with GERD, we conducted a structured literature search using MeSH and free-text terms in MEDLINE (via Pubmed), EMBASE, and Taylor & Francis Online between January 1977 and October 2022. Fifteen articles reporting the prevalence or severity of AB using quality-of-life questionnaires before or after antireflux surgery (ARS) were included. Overall, a high prevalence of AB before ARS was found. A decline in the prevalence and severity of AB was documented postoperatively in most cases independent of the surgical approach. Among surgical approaches, a complete fundoplication had the highest reported postoperative AB. Overall, patients reported less severe and less frequent AB after ARS than before. The traditional belief that postoperative bloating is a sequela of ARS should be reevaluated.
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Affiliation(s)
- Mark Shacker
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | | | - Sumeet K Mittal
- School of Medicine, Creighton University, Phoenix, AZ, USA
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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3
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Hollinghurst J, Smithard DG. Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008-2018. Dysphagia 2022; 37:1612-1622. [PMID: 35212847 PMCID: PMC9643178 DOI: 10.1007/s00455-022-10425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65-74: aged 75-84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
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Affiliation(s)
| | - David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, Woolwich, London, SE18 4QH UK
- University of Greenwich, Avery Hill Campus, Bexley Rd, London, SE9 2PQ UK
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The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis. J Transl Med 2022; 20:175. [PMID: 35410274 PMCID: PMC9003990 DOI: 10.1186/s12967-022-03380-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical complications, such as malnutrition, dehydration, and sever complication, such as aspiration pneumonia, suffocation, and eventually, premature death. The previous studies indicated a various range of prevalence of OD. The present systematic review and meta-analysis aimed to standardize the global prevalence of OD in different populations. Methods A systematic literature review was conducted using Embase, Scopus, PubMed, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and Free Text words, with no time limitation until November 2021. The heterogeneity among studies was quantified using I2 index and the random effects model was used, due to the high heterogeneity among the results of studies included in the meta-analysis. Results The systematic literature search retrieved 2092 studies. After excluding the irrelevant studies, ultimately 27 articles with a sample size of 9841 were included in the meta-analysis. After combining the studies, the overall estimate of the global prevalence rate of OD was 43.8% (95% CI 33.3–54.9%) and the highest prevalence rate was estimated in Africa with 64.2% (95% CI 53.2–73.9%). Given the subgroup analysis based on the study population, the highest prevalence of OD was related to Dementia with 72.4% (95% CI 26.7–95.0%). The results of meta-regression indicated that the prevalence of OD has an increasing trend with the enhancement of year of publication and mean age. Conclusion The results of the present systematic review and meta-analysis revealed that the prevalence of OD is high in different populations and its trend has been increasing in recent years. Therefore, the appropriate strategies should be applied to reduce the prevalence of OD by finding its causation and monitoring at all levels, as well as providing feedback to hospitals.
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Tarlarini C, Greco LC, Lizio A, Gerardi F, Sansone VA, Lunetta C. Taste changes in amyotrophic lateral sclerosis and effects on quality of life. Neurol Sci 2018; 40:399-404. [PMID: 30515604 DOI: 10.1007/s10072-018-3672-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
The primary aim of the study is to evaluate possible taste changes in a cohort of amyotrophic lateral sclerosis patients (pALS) with dysphagia, focusing on eventual psychological and quality of life (QoL) implications. The second aim is to evaluate the changes of QoL following the use of a specific device that provides food flavour. Thirty-two ALS patients were recruited and divided into two groups: subjects feeding only through enteral tube (ET) and subjects still eating by oral way (OW). A specific set of questionnaires was selected and adapted to investigate possible changes of taste and the impact on psychological status and QoL. Moreover, a specific device that provides food flavours in a safety manner was applied to all patients. We found a perceived reduction of taste in ALS patients, in particular in the ET group. All patients showed a strong interest in the preservation of taste, and its loss negatively related to their QoL. The use of the flavour device improved the perceived QoL showing no side effects, even in the ET group. For the first time, our study revealed changes in taste perception in a cohort of ALS patients and the negative consequences that these changes have on psychological status and QoL. Furthermore, the positive effects of the device used to provide flavours suggest a possible rehabilitative effect, which should be better evaluated and confirmed in further studies.
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Affiliation(s)
- Claudia Tarlarini
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Lucia Catherine Greco
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Lizio
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Francesca Gerardi
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Valeria Ada Sansone
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.,Neurorehabilitation Unit, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Christian Lunetta
- Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
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Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 2018; 67:430-440. [PMID: 28232473 DOI: 10.1136/gutjnl-2016-313589] [Citation(s) in RCA: 416] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them. DESIGN Medline, Embase and Embase Classic were searched (until September 2016) to identify population-based studies that reported the prevalence of gastro-oesophageal reflux symptoms in adults (≥15 years); gastro-oesophageal reflux was defined using symptom-based criteria or questionnaires. The prevalence was extracted for all studies, and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, OR and 95% CIs were calculated. RESULTS Of the 14 132 citations evaluated, 102 reported the prevalence of gastro-oesophageal reflux symptoms in 108 separate study populations, containing 460 984 subjects. Prevalence varied according to country (from 2.5% in China to 51.2% in Greece) and criteria used to define gastro-oesophageal reflux symptoms. When only studies using a weekly frequency of heart burn or regurgitation to define presence were considered, pooled prevalence was 13.3% (95% CI 12.0% to 14.6%). Prevalence was higher in subjects ≥50 years (OR 1.32; 95% CI 1.12 to 1.54), smokers (OR 1.26; 95% CI 1.04 to 1.52), non-steroidal anti-inflammatory drug (NSAID)/aspirin users (OR 1.44; 95% CI 1.10 to 1.88) and obese individuals (OR 1.73; 95% CI 1.46 to 2.06). CONCLUSIONS The prevalence of gastro-oesophageal reflux symptoms varied strikingly among countries, even when similar definitions were used to define their presence. Prevalence was significantly higher in subjects ≥50 years, smokers, NSAID users and obese individuals, although these associations were modest.
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Affiliation(s)
- Leonardo H Eusebi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
| | - Raguprakash Ratnakumaran
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Yuhong Yuan
- Division of Gastroenterology, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | | | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
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Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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8
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Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 449] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Herbella FAM, Neto SP, Santoro IL, Figueiredo LC. Gastroesophageal reflux disease and non-esophageal cancer. World J Gastroenterol 2015; 21:815-9. [PMID: 25624714 PMCID: PMC4299333 DOI: 10.3748/wjg.v21.i3.815] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/29/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
The association of gastroesophageal reflux disease (GERD) and esophageal cancer is well known. The carcinogenic properties of the gastroduodenal contents may also lead to cancer in target organs for GERD especially considering that they do not have intrinsic protective mechanisms as found in the esophagus. This review focuses on the putative relation between GERD and non-esophageal cancer. Most of the papers reviewed are far from ideal to prove the relationship of extra-esophageal cancer and GERD since a small number of patients is presented, most do not control cases based on tobacco usage and obesity, and the diagnosis of GERD is variable, not always from an objective measurement such as pH monitoring but relying on symptoms in most reports. Nevertheless, head and neck and lung cancer have a growing incidence parallel to GERD and a shift towards non-smoking, female gender and adenocarcinoma (compared to squamous cell carcinoma) is arising, similar to the example of esophageal cancer with the exception of the female gender.
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Vossoughinia H, Salari M, Mokhtari Amirmajdi E, Saadatnia H, Abedini S, Shariati A, Shariati M, Khosravi Khorashad A. An epidemiological study of gastroesophageal reflux disease and related risk factors in urban population of mashhad, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e15832. [PMID: 25763231 PMCID: PMC4341324 DOI: 10.5812/ircmj.15832] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 09/06/2014] [Accepted: 10/28/2014] [Indexed: 01/11/2023]
Abstract
Background: Gastroesophageal Reflux Disease (GERD) is a chronic and common disease, which is characterized by heartburn and regurgitation. In the last couple of decades, GERD has received much attention and studies have shown an increase in its prevalence. Although there have been a few studies on the prevalence of GERD in Iran, no study has yet been done in the northeastern part of the country. The aim of our study was to evaluate the prevalence of GERD and its risk factors in a population from Mashhad. Objectives: To evaluate the epidemiology of GERD based on a population study in Mashhad. Patients and Methods: This was a cross sectional descriptive study conducted in 2010. In total, 2500 participants were selected based on cluster sampling. Modified and validated Mayo Clinic questionnaire for GERD was used for data collection. Overall, 1685 questionnaires were retrieved. Fifty-one participants were excluded because of pregnancies, history of abdominal surgery and being less than 18 years old. We analyzed data using the SPSS software version 16. Prevalence of GERD and significant risk factors (P value < 0.05) were determined. Results: In total, 420 participants (25.7%) had GERD symptoms. Risk factors with significant effects consisted of smoking, consumption of non-steroidal anti-inflammatory drugs (NASIDs), overeating, chronic diseases, tea and coffee consumption and GERD in spouse. Conclusions: The prevalence of GERD among people living in Mashhad was above the average prevalence in other cities of Iran. However, risk factors seemed to be similar to those reported by other studies.
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Affiliation(s)
- Hassan Vossoughinia
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Masoumeh Salari
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | | | - Hassan Saadatnia
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Siavash Abedini
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Shariati
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammadjavad Shariati
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ahmad Khosravi Khorashad
- Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Ahmad Khosravi Khorashad, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel:+98-5138012742, Fax: +98-5138453239, E-mail:
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11
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Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia 2014; 30:114-20. [PMID: 25432669 DOI: 10.1007/s00455-014-9584-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 10/20/2014] [Indexed: 01/18/2023]
Abstract
Recent and specific data on the prevalence and/or incidence of oropharyngeal dysphagia in the general population are scarce. This study focuses on obtaining this data by means of a literature review and telephone survey. A literature review was performed to obtain data on the prevalence of dysphagia in the general population. Secondly, a quasi-random telephone survey using the functional health status questionnaire EAT-10 was conducted with the aim of establishing prevalence data on oropharyngeal dysphagia in the Netherlands. The literature review revealed six articles which met the inclusion criteria. The prevalence data on oropharyngeal dysphagia in the general population varied between 2.3 and 16 %. For the telephone survey, a total of 6,700 individuals were contacted by telephone, of which, 2,600 (39 %) participated in the study. Of the 2,600 participants, as many as 315 (12.1 %) were identified as having swallowing abnormalities and showed increased risk of oropharyngeal dysphagia with age. Prevalence data on oropharyngeal dysphagia in the Dutch general population were as high as 12.1 %. This data are in line with the retrieved prevalence data from the literature.
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12
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Watson DI, Bright T. For proton pump inhibitor-dependent gastro-oesophageal reflux, laparoscopic fundoplication is superior to medical therapy at 5 years of follow-up. EVIDENCE-BASED MEDICINE 2014; 19:31. [PMID: 23842687 DOI: 10.1136/eb-2013-101403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David I Watson
- Flinders University Department of Surgery, Flinders Medical Centre, , Bedford Park, South Australia, Australia
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Thrift AP, Kendall BJ, Pandeya N, Whiteman DC. A model to determine absolute risk for esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2013; 11:138-44.e2. [PMID: 23103823 DOI: 10.1016/j.cgh.2012.10.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Esophageal adenocarcinoma (EAC) develops rapidly and has a high mortality rate. We aimed to develop a prediction model to estimate the absolute 5-year risks, based on different profiles of factors, for developing EAC. METHODS We derived a risk model using epidemiologic data from 364 patients with incident EAC and 1580 population controls. Significant risk factors were fitted into an unconditional multiple logistic regression model. The final model was combined with age- and sex-specific EAC incidence data to estimate absolute 5-year risks for EAC. We performed a 10-fold cross-validation of the data to assess the relative performance of the model. RESULTS The final risk model included terms for highest level of education, body mass index, smoking status, frequency of gastroesophageal reflux symptoms and/or use of acid-suppressant medications, and frequency of nonsteroidal anti-inflammatory drug use. The population attributable risk for the model was 0.92. A 10-fold cross-validation produced an area under the receiver operating characteristic curve statistic of 0.75 (95% confidence interval, 0.66-0.84), indicating good discrimination. Adding data on alarm symptoms, frequency of symptoms of dysphagia, and unexplained weight loss to the model significantly improved discrimination (area under the receiver operating characteristic curve, 0.85; 95% confidence interval, 0.78-0.91). CONCLUSIONS Risk models can be used to identify people with a higher than average risk for developing EAC; these individuals might benefit from targeted cancer-prevention strategies.
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Affiliation(s)
- Aaron P Thrift
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
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Pandeya N, Green AC, Whiteman DC. Prevalence and determinants of frequent gastroesophageal reflux symptoms in the Australian community. Dis Esophagus 2012; 25:573-583. [PMID: 22128757 DOI: 10.1111/j.1442-2050.2011.01287.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frequent gastroesophageal reflux (GER) causes chronic inflammation and damages esophageal mucosa, which can lead to Barrett's esophagus. It has also been consistently found to be a strong risk factor for esophageal adenocarcinoma. The prevalence of GER appears to vary; however, population-based Australian studies investigating the symptoms are limited. This study aimed to estimate the population prevalence and identify the determinants of frequent GER symptoms in the Australian population. Self-reported information on the frequency of reflux symptoms were collected from 1,580 adults from a population register. We estimated age- and sex-standardized prevalence of occasional (
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Affiliation(s)
- N Pandeya
- School of Population Health, The University of Queensland, Queensland, Australia.
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Thrift AP, Pandeya N, Smith KJ, Green AC, Webb PM, Whiteman DC. The use of nonsteroidal anti-inflammatory drugs and the risk of Barrett's oesophagus. Aliment Pharmacol Ther 2011; 34:1235-44. [PMID: 21967506 DOI: 10.1111/j.1365-2036.2011.04855.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epidemiological studies have consistently reported inverse associations between nonsteroidal anti-inflammatory drugs (NSAIDs) and oesophageal adenocarcinoma, but few have investigated associations with the precursor lesion, Barrett's oesophagus. AIM To investigate the relationship between NSAID use and risk of Barrett's oesophagus. METHODS We conducted a large population-based case-control study that collected information on patterns of intake for aspirin and non-aspirin NSAIDs during the past 5 years and other exposures from 285 patients with nondysplastic Barrett's oesophagus, 108 patients with dysplastic Barrett's oesophagus, and two separate control groups: 313 endoscopy patients with acute inflammatory changes ('inflammation controls') and 644 population controls. We calculated odds ratios (ORs) and 95% CIs using unconditional logistic regression. RESULTS Use of aspirin was not associated with nondysplastic Barrett's oesophagus when compared with population (OR=1.01, 95% CI 0.71-1.43) or inflammation controls (OR=1.16, 95% CI 0.80-1.68). Whereas we observed significant risk reductions for use of non-aspirin NSAIDs when nondysplastic Barrett's oesophagus cases were compared with population controls (OR=0.69, 95% CI 0.49-0.97), the effect was weaker and nonsignificant when cases were compared with inflammation controls (OR=0.82, 95% CI 0.57-1.18), and no dose-response effects were present in either analysis. We found no evidence that aspirin or non-aspirin NSAID use conferred risk reductions for dysplastic Barrett's oesophagus, regardless of the control series. We excluded effect modification by known risk factors as an explanation for these null findings. CONCLUSIONS We found little support for an inverse association between use of NSAIDs and Barrett's oesophagus. The question of whether or not these medications prevent the onset of Barrett's oesophagus remains open.
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Affiliation(s)
- A P Thrift
- School of Population Health, The University of Queensland, Public Health Building, Herston, Brisbane, Australia
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Thrift AP, Pandeya N, Smith KJ, Green AC, Hayward NK, Webb PM, Whiteman DC. Helicobacter pylori infection and the risks of Barrett's oesophagus: a population-based case-control study. Int J Cancer 2011; 130:2407-16. [PMID: 21681741 DOI: 10.1002/ijc.26242] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 06/07/2011] [Indexed: 12/18/2022]
Abstract
Infection with Helicobacter pylori is associated with significantly reduced risks of oesophageal adenocarcinoma; however, few studies have examined the association between H. pylori and Barrett's oesophagus (BO), the precursor lesion. We explored the relationship between H. pylori infection and BO and sought to identify potential modifiers. We compared the prevalence of positive H. pylori serology among 217 adults with simple BO (without dysplasia), 95 with dysplastic BO and 398 population controls sourced from the metropolitan Brisbane area. We determined H. pylori serostatus using enzyme-linked immunosorbent assay. To estimate relative risks, we calculated odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression in the entire sample and stratified by factors known to cause BO. The prevalence of H. pylori seropositivity was 12%, 3%, and 18%, respectively, among patients with simple BO, dysplastic BO and population controls. BO patients were significantly less likely to have antibodies for H. pylori (Simple BO: OR = 0.51, 95% CI: 0.30-0.86; Dysplastic BO: OR = 0.10, 95% CI: 0.03-0.33) than population controls. For simple BO, the association was diminished after adjustment for frequency of gastro-oesophageal reflux (GOR) symptoms. Adjustment for frequency of GOR symptoms did not substantially alter the observed effect for dysplastic BO. Although there was some variation in the magnitude of risk estimates across strata of age, sex, GOR symptoms and use of proton pump inhibitors or H2-receptor antagonists, the differences were uniformly nonsignificant. Helicobacter pylori infection is inversely associated with BO, and our findings suggest that decreased acid load is not the only mechanism underlying the H. pylori protective effect.
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Affiliation(s)
- Aaron P Thrift
- School of Population Health, The University of Queensland, Brisbane, Australia
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Thrift AP, Pandeya N, Smith KJ, Mallitt KA, Green AC, Webb PM, Whiteman DC. Lifetime alcohol consumption and risk of Barrett's Esophagus. Am J Gastroenterol 2011; 106:1220-30. [PMID: 21427711 DOI: 10.1038/ajg.2011.89] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Alcohol is a carcinogen that may increase the risk of Barrett's esophagus (BE) through direct contact with esophageal mucosa. However, few studies have investigated this association and findings have been inconsistent. We sought to examine the association between measures of total and beverage-specific alcohol consumption and BE risk. METHODS We conducted a large population-based case-control study that collected information on lifetime alcohol consumption and other exposures from 285 patients with nondysplastic BE, 108 patients with dysplastic BE, and two separate control groups: 313 endoscopy patients with acute inflammatory changes ("inflammation controls") and 644 population controls. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for categories of average alcohol consumption using unconditional multivariate logistic regression. RESULTS Relative to life-long nondrinkers and consumption of <1 drink/week, consumption of 7-20 drinks/week (OR=0.53, 95% CI: 0.31-0.91) and 21-41 drinks/week (OR=0.37, 95% CI: 0.19-0.73) of total alcohol throughout the life was inversely associated with nondysplastic BE, for comparisons with population controls. Lifetime total alcohol consumption was also inversely associated with dysplastic BE (7-20 drinks/week OR=0.52, 95% CI: 0.19-1.43; 21-41 drinks/week OR=0.22, 95% CI: 0.07-0.73). Similarly, reduced risk estimates were found for comparisons with inflammation controls. The inverse associations were observed separately for beer and wine consumption, with a significant linear trend observed with beer consumption. The risks associated with liquor consumption were up to twofold higher; however, they were not statistically significant. We found no evidence for effect modification by factors known (or suspected) to cause BE. CONCLUSIONS Overall, alcohol consumption does not increase the risk of BE. Significant inverse associations were observed for beer consumption, the underlying reasons for which remain unclear.
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Affiliation(s)
- Aaron P Thrift
- School of Population Health, The University of Queensland, Brisbane, Australia
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Haag S, Andrews JM, Gapasin J, Gerken G, Keller A, Holtmann GJ. A 13-nation population survey of upper gastrointestinal symptoms: prevalence of symptoms and socioeconomic factors. Aliment Pharmacol Ther 2011; 33:722-9. [PMID: 21208245 DOI: 10.1111/j.1365-2036.2010.04564.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous data collected in separate studies using various different survey instruments have suggested some variability in the prevalence of symptoms between nations. However, there is a lack of studies which assess and compare the prevalence of upper gastrointestinal symptoms contemporaneously in various countries using a uniform, standardised method. AIM To determine the prevalence of upper gastrointestinal (UGI) symptoms in 13 European countries, and the association between socioeconomic factors and symptoms using a standardised method. METHODS A representative age- and gender-stratified sample of 23,163 subjects (aged 18-69 years) was surveyed. RESULTS The prevalence of UGI symptoms was 38%. UGI symptoms were most prevalent in Hungary [45%, 95% confidence interval (CI): 42.2-48.4] and lowest in the Netherlands (24%, 95% CI: 21.0-26.2). UGI symptoms were more prevalent in women (39%, 95% CI: 38.4-39.6) vs. men (37%, 95% CI: 36.4-37.6). Heartburn (24%, 95% CI: 23.4-24.6) and acidic reflux (14%, 95% CI: 13.6-14.4) were most common. With age, the prevalence of UGI symptoms decreased (e.g. 18-29 years: 43%, 95% CI: 41.4-44.3 vs. 50-69 years: 33%, 95% CI: 32.3-34.4); in contrast, the frequency of symptom episodes/year increased with age (e.g. 18-29 years: 11.3 episodes per years, 95% CI: 10.5-12.1 vs. 50-69 years: 21.8, 95% CI: 20.7-22.9). Socioeconomic status as measured by gross domestic product was inversely associated with symptoms and in total, socioeconomic factors, gender, body mass index, smoking habits and alcohol consumption explained 83% of the variance of UGI symptoms. CONCLUSIONS There are marked differences in the country specific prevalence of upper gastrointestinal complaints. Socioeconomic factors are closely associated with the prevalence of upper gastrointestinal symptoms.
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Affiliation(s)
- S Haag
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Whiteman DC, Parmar P, Fahey P, Moore SP, Stark M, Zhao ZZ, Montgomery GW, Green AC, Hayward NK, Webb PM. Association of Helicobacter pylori infection with reduced risk for esophageal cancer is independent of environmental and genetic modifiers. Gastroenterology 2010; 139:73-83; quiz e11-2. [PMID: 20399210 DOI: 10.1053/j.gastro.2010.04.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 03/21/2010] [Accepted: 04/01/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Infection with Helicobacter pylori is associated with reduced risk of esophageal adenocarcinoma (EAC), but it is not clear whether this reduction is modified by genotype, other host characteristics, or environmental factors. Furthermore, little is known about the association between H pylori and adenocarcinomas of the esophagogastric junction (EGJAC) or squamous cell carcinomas (ESCC). We sought to measure the association between H pylori infection and esophageal cancer and identify potential modifiers. METHODS In an Australian, population-based, case-control study, we compared the prevalence of H pylori seropositivity and single nucleotide polymorphisms in interleukin (IL)-1B (-31, -511) and tumor necrosis factor (TNF)-alpha (-308, -238) among 260 EAC, 298 EGJAC, and 208 ESCC patients and 1346 controls. To estimate relative risks, we calculated odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression in the entire sample and within strata of phenotypic and genotypic risk factors. RESULTS H pylori infection was associated with significantly reduced risks of EAC (OR, 0.45; 95% CI: 0.30-0.67) and EGJAC (OR, 0.41; 95% CI: 0.27-0.60) but not ESCC (OR, 1.04; 95% CI: 0.71-1.50). For each cancer subtype, risks were of similar magnitude across strata of reflux frequency and smoking status. We found no evidence that polymorphisms in IL-1B or TNF-alpha modified the association between H pylori and EAC or EGJAC. CONCLUSIONS H pylori infection is inversely associated with risks of EAC and EGJAC (but not ESCC); the reduction in risk is similar across subgroups of potential modifiers.
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Hansen JM, Wildner-Christensen M, Schaffalitzky de Muckadell OB. Gastroesophageal reflux symptoms in a Danish population: a prospective follow-up analysis of symptoms, quality of life, and health-care use. Am J Gastroenterol 2009; 104:2394-403. [PMID: 19623171 DOI: 10.1038/ajg.2009.391] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The prevalence of gastroesophageal reflux symptoms (GERS) in the population is high; however, data on long-term follow-up and incidence of GERS in the population are sparse. This study describes the long-term natural history of GERS, the related health-care use, and quality of life in a population followed up for 5 years. METHODS A total of 10,000 randomly selected inhabitants, 40-65 years old, received, as a part of a controlled trial of Helicobacter pylori screening and treatment (control group), a mailed questionnaire regarding demographic data, gastrointestinal symptoms (the Gastrointestinal Symptom Rating Scale (GSRS)), and quality of life (the Short-Form 36-Item Health Survey (SF-36)) at inclusion and after 5 years. GERS was defined as a mean score > or =2 in the reflux dimension in the GSRS. Information on use of health-care resources was drawn from the questionnaires and registers. RESULTS In all, 6,781 individuals answered the first questionnaire and 5-year symptom data were complete for 5,578 (82.3%) of them. The mean age at inclusion was 52.4 years, 48% were men. At inclusion, 22% reported GERS. During follow-up, symptoms resolved in 43%, of whom 10% received acid inhibitory treatment at 5-year follow-up. The incidence of GERS was 2.2% per year. Health-care use during follow-up was significantly higher in individuals with GERS at baseline than in individuals without GERS. Quality of life at 5-year follow-up was lower in individuals with GERS at inclusion than in individuals without GERS at inclusion. CONCLUSIONS GERS are prevalent, long lasting, and associated with an impaired quality of life and substantial health-care use.
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Affiliation(s)
- Jane Møller Hansen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense C 5000, Denmark.
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Current and past smoking significantly increase risk for Barrett's esophagus. Clin Gastroenterol Hepatol 2009; 7:840-8. [PMID: 19410015 DOI: 10.1016/j.cgh.2009.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/09/2009] [Accepted: 04/20/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma; the incidence of this cancer is rapidly increasing in Western populations. However, few population-based studies of BE have been conducted, so little is known about potentially modifiable causes of this disease. METHODS The study included patients with newly diagnosed BE, confirmed by histology and categorized as simple BE (without dysplasia, n = 285) or dysplastic BE (with dysplasia, n = 108). We recruited 2 separate control groups: endoscopy patients with acute inflammatory changes (inflammation controls, n = 313) and population controls sampled from a population register (n = 644). Data were collected through standardized questionnaires and telephone interviews. We fit logistic regression models to calculate odds ratios (ORs) for BE associated with salient exposures by using each set of controls. RESULTS Relative to never smokers, risks of simple BE were significantly higher among former smokers (OR, 2.39; 95% confidence interval, 1.59-3.60) and current smokers (OR, 2.41; 95% confidence interval, 1.39-4.17), compared with population controls. Smoking conferred more than a 4-fold increase in risk for dysplastic BE; this increase in risk remained long after individuals quit smoking. We found no conclusive association between BE and passive smoking and no evidence of independent associations between body mass index (BMI) and simple BE or dysplastic BE, after adjusting for reflux and other factors. Analyses with inflammation controls produced qualitatively similar risk estimates for smoking and BMI to those obtained for population controls, but they were markedly attenuated for reflux, as expected. CONCLUSIONS Current and past smoking significantly increases risk for BE, but BMI does not, after adjustment for the effect of reflux.
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