Presentation and Epidemiology of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder in the United States, and leads to substantial morbidity, though associated mortality is rare. The prevalence of GERD symptoms appeared to increase until 1999. Risk factors for complications of GERD include advanced age, male sex, white race, abdominal obesity, and tobacco use. Most patients with GERD present with heartburn and effortless regurgitation. Coexistent dysphagia is considered an alarm symptom, prompting evaluation. There is substantial overlap between symptoms of GERD and those of eosinophilic esophagitis, functional dyspepsia, and gastroparesis, posing a challenge for patient management.

Keywords: Barrett’s Esophagus; Erosive Esophagitis; Esophageal Stricture.

Figure 1. Prevalence of weekly gastroesophageal reflux symptoms worldwide, based on symptoms at a frequency of once a week or more

(Adapted from Eusebi, et al. Gut. 2017. doi: 10.1136/gutjnl-2016-313589)(34)

Figure 2. Age distribution of GERD-related US hospitalization discharge diagnoses

Upper graphs: age fractions expressed as percent of all patients with a given diagnosis. Lower left graph: age-specific rates of first-listed adenocarcinoma per 100 000, reflux esophagitis per 100 000, esophageal reflux per 10 000, Barrett’s esophagus per 100 000, hiatal hernia per 10 000, and esophageal stricture per 10 000 US population. Lower right graph: age-specific rates of all-listed adenocarcinoma per 100 000, reflux esophagitis per 10 000, esophageal reflux per 10 000, Barrett’s esophagus 10 000, hiatal hernia per 1000, and esophageal stricture per 10 000 US population. (From Thukkani N. & Sonnenberg A., Alimentary Pharmacology and Therapeutics. 2010;31(8):852–61).(36)