Review
Systematic Review on Epidemiology of Gastroesophageal Reflux Disease in Asia

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Background & Aims: The epidemiology of gastroesophageal reflux disease (GERD) has been a subject of much interest in recent years. This review ascertains the prevalence of GERD in eastern and southeastern Asia, and reports on complications and risk factors. Methods: This qualitative systematic review of the epidemiology of GERD in eastern and southeastern Asia identified studies in adults reported in English in the Medline database (searched through April 2005), relevant reviews, and our own bibliographic databases. Results: Thirteen studies were included. 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 and may be increasing. No reliable data are available on the prevalence of esophagitis in the general population. In case studies, the prevalence of reflux esophagitis ranged from 3.4% to 16.3%. Well-established risk factors for GERD in Asian populations included hiatus hernia and obesity. Age and male sex also may be risk factors. Chest pain is the predominant extraesophageal manifestation of GERD in China, whereas in Japan, a link with asthma has been implicated in patients with severe esophagitis. Conclusions: There is a paucity of studies reporting the prevalence of GERD in eastern and southeastern Asia. These results highlight the need for further epidemiologic studies using representative study populations and a standardized methodology. Recognition and awareness of GERD need to increase concomitantly to ensure appropriate diagnosis and treatment of the disease.

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Data Selection

A computerized literature search was performed in the PubMed and Medline databases for relevant articles through April 2005. The search terms were selected to identify studies describing the epidemiology of GERD in eastern Asia and southeastern Asia. Three inclusive searches were conducted and combined using the following search terms in full Medline and Medical Subject Headings (MeSH): (Asia, China, Taiwan, Japan, North Korea, South Korea, Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar,

Results

Our initial search identified 301 results, of which 17 evaluated the prevalence or incidence of GERD or heartburn in eastern and southeastern Asia. Four of these were excluded: 2 because they described only data from infants and/or children10, 11 and 2 because they were not available in English.12, 13 This left 13 studies for review (Table 1): 5 were from China (including 1 follow up-study14),14, 15, 16, 17, 18 4 from Japan,19, 20, 21, 22 3 from Singapore (2 on the same study, 1 follow-up

Prevalence of Gastroesophageal Reflux Disease

Wong et al15 reported a prevalence of 2.5% of frequent reflux symptoms, defined as heartburn and/or acid regurgitation occurring at least once a week, in a population study in Hong Kong (n = 2209). Random telephone interviews were performed using the Chinese version of the well-validated Gastroesophageal Reflux Questionnaire,27 and the response rate was 61%. In a 1-year follow-up investigation of the above study, Wong et al14 showed an increased prevalence of weekly GERD symptoms from 2.5% to

Esophageal Complications of Gastroesophageal Reflux Disease

A number of esophageal complications are associated with GERD, with reflux esophagitis (Table 2) and Barrett’s esophagus among the most extensively studied. The study by Pan et al17 reported a prevalence for esophagitis of 21.4% (9 of 42) in individuals with symptoms of GERD. From this, Pan et al calculated an estimated population prevalence of 1.9% for reflux esophagitis in Beijing and Shanghai. However, the very small subgroup included in the second phase of the study suggests that additional

Extraesophageal Manifestations of Gastroesophageal Reflux Disease

A significant association of GERD with chest pain, chronic cough, hoarseness of voice, asthma, and pneumonia was reported in the general population of Hong Kong, although only chest pain remained significantly associated with GERD on multiple logistic regression analysis (odds ratio, 2.7; 95% confidence interval, 2.1–3.5).15 This association was supported by a second study conducted in Hong Kong in which abnormal gastroesophageal reflux was observed in 29% of chest pain patients with normal

Risk Factors for Gastroesophageal Reflux Disease and Its Complications

Alcohol consumption and the presence of a hiatus hernia were identified as risk factors for GERD and esophagitis in the Malaysian study by Rosaida and Goh39 (Figure 1). A body mass index greater than 25 also was found to be a risk factor for GERD, but not for esophagitis. Cigarette smoking and alcohol consumption were identified as risk factors for GERD in the study of male Japanese employees by Watanabe et al20 (controls, n = 3819; GERD, n = 276).

There may be an effect of age and male sex

Discussion

There is a paucity of data available on the prevalence of GERD in Asia. Our search identified only 13 studies for review (Table 1), 9 of which were from mainly urban areas in China or Japan. These results highlight the pressing need for additional GERD prevalence studies in Asia, using a representative study population and standardized, well-validated questionnaires.

The diagnosis of GERD depends on the frequency and severity of gastroesophageal reflux symptoms. For adults with at least weekly

Acknowledgement

The authors would like to acknowledge the editorial assistance provided by Dr Anja Becher, Dr Becky Fox-Spencer, and Dr Chris Winchester in preparing this article.

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    Supported in part by grants-in-aid for Scientific Research from the Ministry for Education, Science, and Culture of Japan (to Y.K.).

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