Epidemiology of gastro-oesophageal reflux disease: a systematic review

Abstract

A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated. An approximate prevalence of 10-20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%. The incidence in the Western world was approximately 5 per 1000 person years. A number of potential risk factors (for example, an immediate family history and obesity) and comorbidities (for example, respiratory diseases and chest pain) associated with GORD were identified. Data reported in this systematic review can be interpreted with confidence as reflecting the epidemiology of "true" GORD. The disease is more common in the Western world than in Asia, and the low rate of incidence relative to prevalence reflects its chronicity. The small number of studies eligible for inclusion in this review highlights the need for global consensus on a symptom based definition of GORD.

Figure 1

Schema illustrating the need to distinguish between individuals who report minor reflux induced symptoms and those in whom these symptoms have significant impacts. The latter group makes up a minority of those who report reflux induced symptoms in population surveys.

Figure 2

Global variation in the prevalence of gastro-oesophageal reflux disease, defined as at least weekly heartburn and/or acid regurgitation.

Figure 3

Ethnic/regional differences in the prevalence of at least weekly heartburn alone, or at least weekly heartburn and/or acid regurgitation. Data are shown for population studies that satisfied criteria for inclusion in this review which evaluated specific ethnic groups. Data are from the studies indicated.

Figure 4

Factors associated with gastro-oesophageal reflux disease (GORD), suggesting their a priori likelihood of being influenced by the disease.

Figure 5

Data from a twin study which show evidence of a substantial contribution of genetic factors to occurrence of reflux disease, based on a high concordance for the presence of this problem in monozygotic compared with dizygotic twins.