Prevalence of GERD in Southeast Asian countries

Abstract

The reported population prevalence of GERD in eastern Asia ranged from 2.5% to 6.7% for at least weekly symptoms of heartburn and/or acid regurgitation. Typical GERD symptoms are consistently less common among the general populations of Asia than those in the West which have a prevalence of around 20% for weekly refl ux symptoms. No reliable data are available on the prevalence of esophagitis in the general population. In case studies the prevalence of refl ux esophagitis ranged from 3.4% to 16.3%. A large study in Hong Kong in patients undergoing routine or emergency upper endoscopy (n=16,606) showed that 3.8% of the patients had esophagitis demonstrated by endosocpy and the majority (94%) had Los Angeles Classifi cation Grade A or B esophagitis and only 14 patients (0.08%) had esophageal stricture. Rosaida et al. have shown that in a prospective study, 65.5% of their patients had NERD. In another study from Hong Kong, it was found that 46.7% (215 of 460 subjects) of patients with typical refl ux symptoms had no endoscopic evidence of esophagitis. In a study from Singapore, patients with NERD were signifi cantly younger, more likely to have minor psychiatric morbidity and were less likely to respond to proton pump inhibitors (PPI) when compared with patients with erosive esophagitis. In summary, the prevalence of refl ux esophagitis appears to be lower in Asian population and the disease spectrum is milder in Asians. Prevalence of Barrett's varies between different countries. In a study of multi-ethnic Malaysian population, Barrett's esophagus was reported in 1.6% of those undergoing elective endoscopy for upper abdominal or refl ux complaints. A much lower prevalence was found in southern Chinese patients undergoing upper endoscopy, of whom only 0.06% were found (n=22,628). More data are required to determine the true prevalence of Barrett's esophagus in Asians. The prevalence of GERD in Asia may be increasing. In a 1999 re-survey of a cohort of community residents in Singapore who were interviewed in an earlier study in 1994, Lim et al. reported a more than 6 fold increase in the reporting of refl ux symptoms, from a prevalence of 1.6% to a prevalence of 9.9%. In a 1-year follow up study in Hong Kong, Wong et al. reported an increase in the annual, monthly and weekly prevalence of GERD from 29.8%, 8.9% and 2.5% to 34.1%, 10.1% and 2.7%, respectively. REFERENCES: 1. Wong WM, Lai KC, Lam KF, Hui WM, Hu WH, Lam CL, Xia HH, Huang JQ, Chan CK, Lam SK, Wong BC. Prevalence, clinical spectrum and health care utilization of gastro-oesophageal refl ux disease in a Chinese population: a population-based study. Aliment Pharmacol Ther 2003;18:595-604. 2. Wong WM, Lai KC, Lam KF, Hui WM, Huang JQ, Xia HH, Hu WH, Lam CL, Chan CK, Lam SK, Wong BC. Onset and disappearance of refl ux symptoms in a Chinese population: a 1-year follow-up study. Aliment Pharmacol Ther 2004;20:803-12. 3. Wong BC, Kinoshita Y. Systematic review on epidemiology of gastroesophageal refl ux disease in Asia. Clin Gastroenterol Hepatol 2006;4:398-407. 4. Wong WM, Lam SK, Hui WM, Lai KC, Chan CK, Hu WH, Xia HH, Hui CK, Yuen MF, Chan AO, Wong BC. Long-term prospective follow-up of endoscopic oesophagitis in southern Chinese--prevalence and spectrum of the disease. Aliment Pharmacol Ther 2002;16:2037-42.