Epidemiology of symptom-defined gastroesophageal reflux disease and reflux esophagitis: The systematic investigation of gastrointestinal diseases in China (SILC)

Abstract

Objective. Gastroesophageal reflux disease (GERD) is thought to be less prevalent in China than in Western countries. However, essential population-based endoscopy data are lacking for this country. Material and methods. As part of a wider study, 3600 individuals selected randomly from the Shanghai region were asked to undergo endoscopy. Participants completed a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire. When sufficient numbers were available, associations were assessed using multiple logistic regression or the Wilcoxon rank-sum test. Results. Of 3153 (87.6%) individuals who completed the survey, 1030 (32.7%) agreed to endoscopy and 1029 endoscopies were suitable for analysis. Symptom-defined GERD was more prevalent in the endoscopy group (4.7%) than in the non-endoscopy group (1.7%). Prevalence estimates were 6.4% for reflux esophagitis, 1.8% for endoscopically suspected esophageal metaplasia and 0.7% for hiatus hernia. Reflux esophagitis was more prevalent in patients with symptom-defined GERD than in those without (12.5% [6/48] vs. 6.1% [60/981]), and was significantly associated with reflux symptoms of any frequency or severity (OR = 2.10, 95% CI 1.13–3.89) and with negative Helicobacter pylori infection (OR = 0.44, 95% CI 0.25–0.80). Only 28.8% of participants with reflux esophagitis had heartburn and/or regurgitation symptoms. Epigastric burning was significantly more severe and frequent in participants with reflux esophagitis than in those without (p = 0.05). Conclusions. Reflux esophagitis is less prevalent in China than reported in Western countries. Further work is needed to establish why reflux esophagitis appears less symptomatic in China than in Western countries.

Key Words::

• China
• endoscopy
• epidemiology
• gastroesophageal reflux
• peptic esophagitis

Acknowledgements

We thank Michael Molloy-Bland, from Oxford PharmaGenesis^™ Limited, who provided writing support funded by AstraZeneca R&D, Mölndal. We also thank Paula Fernström from AstraZeneca R&D Mölndal for providing input into the study design.

Funding: The study was funded by AstraZeneca R&D, Mölndal, Sweden. AstraZeneca had no role in the content and conduct of the study.

Declaration of interest: X. Yan, R. Wang, Y. Zhao, X. Ma, D. Zou, Z. Li, J. Chen, X. Shi, Y. Gong, X. Man and L. Gao declare that they have no competing interests. J. He has served as the Director of the Department of Health Statistics, Second Military Medical University and has received research funding from AstraZeneca. J. Dent has served as a speaker, a consultant and an advisory board member for AstraZeneca, and has received research funding from AstraZeneca. J. Sung has served as a speaker, a consultant and an advisory board member for AstraZeneca, and has received research funding from AstraZeneca. B. Wernersson and Saga Johansson are employees of AstraZeneca. W. Liu was an employee of AstraZeneca at the time the study was conducted and is now employed by Genzyme.