Prevalence of GERD in a community-based examination in Thailand

Abstract

Background : Gastroesophageal reflux disease (GERD) is highly prevalent, affecting 10 - 30% of the population in Western countries. In Asia, the prevalence of GERD is lower, ranging from 2.5 - 7.1% in most population-based studies. Recently, GERD has been increasingly encountered in clinical practices in Asian countries.

Objectives : To describe the prevalence of GERD in a community-based endoscopic examination in Thailand and to assess the relationship between the endoscopic findings of esophagitis and GERD symptoms.

Materials and Method : The adults aged of at least 18 years old with uninvestigated dyspeptic symptoms or the adults aged of at least 55 years old with or without alarming symptoms were invited to participate voluntary. Esophagogastroduodenoscopy (EGD) was performed in 2,488 participants from 5 different geographic regions of Thailand. A questionnaire was used to inquire the specific GERD symptoms in all participants. The cardinal symptoms of GERD are heartburn, acid reflux and food regurgitation. Endoscopic findings were recorded and an antral biopsy was performed and tested for Helicobacter pylori using a rapid urease test (Pronto dry). The endoscopic finding of esophagitis was correlated with reflux symptoms in each subject.

Results : There were 2,488 participants in this community-based endoscopic examination study, consisting of 785 men (31.6%) and 1,703 women (68.4%) with the mean ± SD age of 50.2 ± 11.9 years. There were 62.8% of participants (n = 1563) with dyspeptic symptoms whereas 37.2% of the participants (n = 925) were asymptomatic. We found typical reflux symptoms in 855 participants (34.4%); 143 of them had only reflux symptoms and 712 had overlapping symptoms of GERD and dyspepsia. Alarm symptoms, which included significant weight loss and dysphagia, were found in 13.3% (n = 330). Of 855 participants with typical reflux symptoms, only 6.2% of them (n = 53) had endoscopic esophagitis, whereas the group without typical reflux symptoms, including those with asymptomatic and dyspeptic participants (n = 1,633), endoscopic esophagitis was detected in 4.8% (n = 78). The majority of endoscopic esophagitis patients were of mild degree (LA class A = 93%). Participants with typical reflux symptoms (n = 313) had H. pylori infection rate of 36.6% which was significantly lower than those participants without the typical reflux symptoms (n = 686; 42%, P = 0.01) whereas H. pylori infection rate was not different in participants with or without endoscopic esophagitis.

Conclusion : From our community–based endoscopic examination study, the prevalence of GERD using typical reflux symptoms is about one-third (34.4%) whereas only 6.2% of them had endoscopic esophagitis with mild esophagitis predominantly. This suggests that non-erosive reflux disease (NERD) is the most common category of GERD among the Thai participants who experienced typical reflux symptoms.