Time Trends of Gastroesophageal Reflux Disease: A Systematic Review

doi:10.1016/j.cgh.2006.09.016

Clinical Gastroenterology and Hepatology

Volume 5, Issue 1, January 2007, Pages 17-26

https://doi.org/10.1016/j.cgh.2006.09.016 Get rights and content

There is a perception that the prevalence of gastroesophageal reflux disease (GERD) is increasing, but few studies have directly tackled this issue. By using a systematic approach, this review aimed to assess objectively whether the prevalence of GERD is changing with time. First, population-based studies that reported the prevalence of at least weekly heartburn and/or acid regurgitation were subjected to a time-trend analysis with a Poisson regression model. Second, population-based studies reporting the prevalence of GERD symptoms at 2 time points in the same source population were reviewed. Third, longitudinal studies that charted the prevalence of GERD symptoms and esophagitis in primary and secondary care were examined. The Poisson model revealed a significant (P < .0001) trend for an increase in the prevalence of reflux symptoms in the general population over time. Separately, significant increases with time were found for North America (P = .0005) and Europe (P < .0001) but not Asia (P = .49). Studies of the same source population over time indicated an increase in the prevalence of GERD in the U.S., Singapore, and China but not Sweden. An increase in the prevalence of GERD or esophagitis was found in the majority of longitudinal studies. There is evidence that the prevalence of GERD has increased during the past 2 decades. If this trend continues, it could contribute to the rapidly increasing incidence of more serious complications associated with GERD, such as esophageal adenocarcinoma, as well as costs to healthcare systems and employers.

Section snippets

Study Search

Studies were identified via PubMed searches with the search terms heartburn, gastroesophageal reflux, reflux, or esophagitis, along with prevalence or incidence. The author’s existing bibliographic database and recent reviews on the epidemiology of GERD1, 10, 11 were also searched for useful references.

Cross-sectional population-based studies

The literature searches identified 45 population-based studies that measured the prevalence of GERD. To allow comparison of studies from various populations, additional criteria were imposed on

Cross-sectional population-based studies

The prevalence of GERD symptoms in the 17 studies included in the meta-analysis are presented graphically in Figure 1 and show a trend toward a higher prevalence of GERD in studies conducted more recently, as well as clearly demonstrating a lower prevalence in Asia compared with North America. The Asian studies and the 1 South American study are all relatively recent, whereas the European and North American studies span a greater number of years. The earlier studies also tended to record the

Discussion

This systematic review has used data from several types of studies that examine the prevalence of GERD to obtain as broad a perspective as possible on the issue of whether the incidence of GERD is changing with time. First, a total of 17 cross-sectional population-based studies of GERD symptoms were included in a Poisson regression analysis, which revealed a significant increasing trend in the prevalence of GERD between 1982–2005 (P < .001). Furthermore, it appears that this trend is gradually

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¹: Dr El-Serag is a VA Health Services Research & Development Awardee (grant no. ARCD 00-013-2). Also supported by an unrestricted education research grant from AstraZeneca R&D Mölndal.

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ReviewTime Trends of Gastroesophageal Reflux Disease: A Systematic Review

Section snippets

Study Search

Cross-sectional population-based studies

Cross-sectional population-based studies

Discussion

Am J Med Sci

Am J Gastroenterol

Gastroenterology

Gastroenterology

Am J Gastroenterol

Am J Gastroenterol

Gastroenterology

Dig Liver Dis

Gastroenterology

Gastroenterology

Clin Gastroenterol Hepatol

Gastroenterology

Epidemiology of gastro-oesophageal reflux disease: a systematic review

Gut

Clinical practice pattern of gastroenterologists, primary care physicians, and otolaryngologists for the management of GERD in the Asia-Pacific region: the FAST survey

J Gastroenterol Hepatol

Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview

J Gastroenterol Hepatol

Review article: prevalence and epidemiology of gastro-oesophageal reflux disease

Aliment Pharmacol Ther

Review article: prevalence and epidemiology of gastro-oesophageal reflux disease in Japan

Aliment Pharmacol Ther

Systematic review: the impact of gastro-oesophageal reflux disease on health-related productivity

Aliment Pharmacol Ther

Prevalence of upper gastrointestinal symptoms in the general population: a systematic review

Scand J Gastroenterol Suppl

Systematic review: the prevalence and clinical course of functional dyspepsia

Aliment Pharmacol Ther

Comparison of two methods to detect publication bias in meta-analysis

JAMA

The prevalence of symptoms suggestive of esophageal disorders

Scand J Gastroenterol

The occurrence and future history of oesophageal symptoms in an urban Swedish population: results of a questionnaire based, ten-year follow up study

Scand J Gastroenterol

Changing prevalence of gastroesophageal reflux with changing time: longitudinal study in an Asian population

J Gastroenterol Hepatol

Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a population-based study

Aliment Pharmacol Ther

Onset and disappearance of reflux symptoms in a Chinese population: a 1-year follow-up study

Aliment Pharmacol Ther

Changing impact of gastroesophageal reflux in medical and otolaryngology practice

Laryngoscope

Outpatient experience of patients with GERD in the United States: analysis of the 1998-2001 National Ambulatory Medical Care Survey

Dig Dis Sci

Relationship between gastroesophageal reflux symptoms and esophagitis in the general population: results from the Loiano-Monghidoro study

Gastroenterology

Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese

Scand J Gastroenterol

Opposing time trends of peptic ulcer and reflux disease

Gut

Open-access upper alimentary endoscopy

Br J Hosp Med

Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy

Digestion

Increasing trend of reflux esophagitis and decreasing trend of Helicobacter pylori infection in patients from a multiethnic Asian country

Am J Gastroenterol

Opposing time trends in the prevalence of duodenal ulcer and reflux esophagitis in a multiracial Asian population

Gastroenterology

The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence

J Natl Cancer Inst

Secular trends in the epidemiology and outcome of Barrett’s oesophagus in Olmsted County, Minnesota

Gut

Increasing incidence of Barrett’s oesophagus in the general population

Gut

Increased detection rates of Barrett’s oesophagus without rise in incidence of oesophageal adenocarcinoma

Swiss Med Wkly

Review
Time Trends of Gastroesophageal Reflux Disease: A Systematic Review