Insight into global burden of gastroesophageal reflux disease: Understanding its reach and impact

Table 1 Common symptoms of gastroesophageal reflux disease

Ref.	Symptom
[97]	Non cardiac chest pain
[11]	Heartburn
[20]	Regurgitation
[98]	Dysphagia
[99]	Globus sensation
[13]	Epigastric pain
[100]	Dyspepsia
[101]	Belching
[102]	Gall bladder disease
[33]	Nausea
[103]	Headache
[104]	Disturbance of sleep
[13]	Dental erosions
[105]	Increased salivation
[106]	Temporomandibular dysfunction
[107]	Chronic cough
[108]	Laryngitis
[109]	Asthma
[110]	Chronic otitis media
[111]	Chronic sinusitis
[112,113]	Taste and smell changes
[114]	Asymptomatic

Table 2 Los Angeles classification of reflux esophagitis

Grade	Criteria
A	One or more mucosal breaks < 5 mm that do not extend between the tops of two mucosal folds
B	One or more mucosal breaks > 5 mm that do not extend between the tops of two mucosal folds
C	One or more mucosal breaks that are continuous between the tops of two or more mucosal folds but that involve < 75% of the circumference

Table 3 Diseases with symptoms overlapping with gastroesophageal reflux disease

Ref.	Diseases with overlapping symptoms
[115]	Eosinophilic esophagitis
[116]	Infectious esophagitis
	Esophageal candidiasis
	Herpes and cytomegalovirus esophagitis
[117]	Drug-induced esophagitis
[118]	Achalasia and esophageal motility disorders
[119]	Pharyngeal and esophageal diverticula, rings, and webs
[120]	Disorders of gastric motility/ gastroparesis
[121]	Gastritis & peptic ulcer disease
[122]	Gluten-related disorders
[123]	Functional gastrointestinal disorders: Functional chest pain, functional heartburn, reflux hypersensitivity, globus sensation, functional dysphagia, functional dyspepsia, postprandial distress syndrome, epigastric pain syndrome, belching disorders, and rumination syndrome
[124]	Functional abdominal bloating/distension and esophageal and gastric carcinoma
[125]	Cardiac disease
[126]	Gall bladder and pancreatic diseases

Table 4 Tools and questionnaires developed and used for gastroesophageal reflux disease screening

Tool or questionnaire	Abbreviation
Gastroesophageal reflux disease questionnaire	GerdQ
Reflux Disease Questionnaire	RDQ
Carlsson-Dent Questionnaire	CDQ
Bowel Disease Questionnaire	BDQ
Frequency Scale for the Symptoms of GERD	FSSG
General Health Questionnaire-28	GHQ-28
Gastrointestinal Symptom Rating Scale	GSRS
Domestic/International Gastroenterology Surveillance Study	DIGEST
Subjective Symptom Assessment Profile	SSA-P
GERD Symptom and Medication Questionnaire	GERD-SMQ
Chest Pain Questionnaire	CPQ
Quality of Life and Utility Evaluation Survey Technology	QUEST
Infant Gastro-Esophageal Reflux Questionnaire	I-GERQ
GERD Activity Index	GRACI
Esophageal Symptom Questionnaire
Standardized Esophageal Symptom Questionnaire
Ulcer Esophagitis Subjective Symptoms Scale	UESS
GERD Activity Index	GRACI
Digestive Health Status Instrument	DHSI
Modified Bowel Disease Questionnaire	BDQ
GERD Symptom Assessment Scale	GSAS
GERD Screener

GERD: Gastroesophageal reflux disease.

Table 5 Pooled prevalence of gastroesophageal reflux disease according to geographical location

Geographical location	Number of studies used for calculation by Nirwan et al[34], 2020	Number of participants	GERD prevalence, %
Global
Overall	102	469899	13.98
Male	50	122849	15.69
Female	50	138435	17.17
Hemisphere
Western			10-20[6,55]
Eastern			2-7[6,127]
Continents
Asia	54	240451	12.92
Europe	29	90057	14.12
North America	9	20525	19.55
Latin America and the Caribbean	4	12756	12.88
Oceania	4	3760	13.78
Africa	2	2350	NA
Countries
China	10	36887	4.16
Japan	7	27912	13.81
South Korea	7	43897	5.84
Taiwan	1	1238	NA
Indonesia	1	278	NA
Bangladesh	1	2000	5.25[56]
India	3	6296	NA
Iran	16	102295	18.43
Turkey	4	13332	22.4
Israel	2	3008	NA
Saudi Arabia	2	3308	NA
Poland	1	850	NA
Romania	1	184	NA
Russia	2	8877	NA
Albania	1	845	NA
Italy	2	2032	NA
Greece	1	700	NA
Spain	3	5365	NA
Switzerland	2	7736	NA
Netherlands	1	502	NA
France	2	46377	NA
Germany	1	268	NA
Sweden	4	8120	16.15
Finland	1	1700	NA
Norway	1	44997	NA
United Kingdom	4	12467	14.53
Denmark	1	48027	NA
United States	8	19489	21.04
Canada	1	1036	NA
Argentina	1	839	NA
Brazil	1	3934	NA
Uruguay	1	1141	NA
Colombia	1	6842	NA
Australia	3	2982	12[62], 9.2[63]
New Zealand	1	778	NA
Nigeria	1	410	NA
Côte d’Ivoire	1	1940	NA
Sri Lanka	1	1200	23.5[59]

GERD: Gastroesophageal reflux disease; NA: Not available.

Table 6 Factors associated with gastroesophageal reflux disease symptoms

Factor	Evidence
Age	With increasing age, the elasticity of the pharyngoesophageal membrane reduces, progressively leading to hiatal hernias, predisposing to GERD[128]; the prevalence of GERD symptoms is highest in those aged 40 to 59 years in the systematic review by Nirwan et al[34]
Gender	Females had a slightly higher prevalence of GERD than males in systematic reviews by Nirwan et al[34] and Friedland et al[128]
Education level	Those with the lowest education level had the highest GERD prevalence, whilst those with the highest level of education had the lowest GERD prevalence[34,129]
Ethnicities	Ethnicities can play a role in development of GERD even in the same country[14], though some studies did not find any significant difference[59]
Economic strata	Lower-income groups are reported to have a significantly higher prevalence of GERD[34,128]
Urban or rural	GERD is reported to be higher in urban populations[34,74,130]
Obesity	Obesity is an identified risk factor for GERD[34,131,132]
Mental stress	Mental stress is shown to increase GERD symptoms[9,133]
Diet	Common food items associated with GERD are: Spices[10], carbonated beverages[134], wheat products[135], tea[136], coffee[137], sour and acidic food[138], alcohol[78], chocolate[139], dietary sugar[140]
Habits	Habits associated with GERD include: Large meals[141], sleeping after eating a meal[142], eating a meal fast[135], habit of midnight snacks[143], skipping meals[143], inadequate sleep[134], exercise[142,144], smoking[145]
Diseases and treatments	Some diseases such as asthma[146], diabetes mellitus[147], and different medications[148-151] are known to be associated with GERD symptoms

GERD: Gastroesophageal reflux disease.