GERD Prevalence, Diagnosis and Treatments
Either slight heartburn and/or regurgitation for at least 2 days per week or moderate to severe symptoms for at least one day per week is considered a substantial symptom-based diagnosis. GERD phenotypical classifications are non-erosive reflux disease (NERD), erosive esophagitis (EE), and Barrett’s esophagus (BE). A review study reported 15%–20% of the Western population experience reflux on a weekly basis which may lead to significant economic consequences. The reported frequency of GERD in a sample of countries was: Italy (11.8%), Sweden (15.5%), China, Japan, Korea (3.4%– 8.5%), and Taiwan (9%–24.6%). Erosive esophagitis and hiatus hernia are more wide spread in Europe than in Asia (except Taiwan, in which similar EE frequency as Europe was reported. In recent years, the frequency of GERD is rising in the US, Western Europe (including Scandinavia) by nearly 5% every year. The prevalence of GERD is also rising in Asian countries. One of the most detailed data on GERD prevalence is from Taiwan, where most people have Chinese origin. IA prevalence of 14.5% was reported in 1991, which rose to 25%-26% in the years 2007 to 2011. From an economic standpoint, GERD consequences are loss of work days and higher cost of public health. From the medical aspect, GERD is related to a higher risk of esophageal cancer. Half a percent of GERD patients will develop BE every year. Barrett’s esophagus is a known risk for esophageal cancer. Thus GERD increases the risk of esophageal cancer by 5-8.6-fold. The diagnosis of GERD and its related clinical symptoms is challenging. A third of GERD patients have atypical symptoms or even are asymptomatic. Some extraesophageal symptoms or atypical complaints are Laryngopharingeal reflux (10%), coughing (13%), and asthma (4.8%). Trying proton pump inhibitors (PPI) which lead to a temporal improvement in symptoms was suggested as an indirect diagnostic method, but there is a risk that BE, RE, and even esophageal cancer may be missed. PPIs have been the most effective treatment for GERD but discontinuation of their use will likely lead to the return of the symptoms. PPIs will not resolve refractory GERD, NERD, EE, and BE. Moreover, evidence for long-term PPI related side effects include a rising frequency of hip fracture in postmenopausal women, pneumonia, enteric infections and drug-drug interactions with clopidogrel. Another challenge with long-term PPI use is the inconsistency and financial health costs. Hence, patients may search for other possible treatment such as surgery or endoscopic intervention. Interventional procedures for the treatment of GERD, either via surgery or endoscopically, aim at creating a mechanical barrier to address the pathophysiology in GERD.