Gastroesophageal reflux among different racial groups in the United States.
OBJECTIVE
White people in the United States are several-fold more affected by esophageal adenocarcinoma than black people. It remains unknown whether this racial discrepancy reflects a higher prevalence of gastroesophageal reflux disease (GERD) symptoms or a higher degree of esophageal damage.


METHODS
A cross-sectional survey followed by endoscopy was performed among employees at a VA medical center. The association between race and GERD symptoms and erosive esophagitis was analyzed in logistic regression analyses controlling for demographic, clinical, and histologic variables.


RESULTS
A total of 496 of 915 people (54%) returned interpretable questionnaires, and endoscopy was performed in 215 participants. The mean age was 45 years, and 336 (68%) were women. Racial distribution was 43% black, 34% white, and 23% other races. Heartburn occurring at least weekly was reported in 27%, 23%, and 24% of these racial groups, respectively. The age-adjusted prevalence of heartburn or regurgitation was not significantly different among the groups. Erosive esophagitis was found in 50 of 215 participants (23%); 31 of these cases were mild. Only one person had Barrett's esophagus (0.4%). For weekly heartburn or regurgitation, black participants had significantly less frequent erosive esophagitis than white participants (24% vs. 50%; P = 0.03). With multiple adjustments, black participants had a persistently lower risk of esophagitis (adjusted odds ratio, 0.22-0.46; P < 0.001).


CONCLUSIONS
White and black people in the United States have a similarly high prevalence of GERD symptoms. However, black people have a lower prevalence of esophagitis for the same frequency of GERD symptoms. Barrett's esophagus was rare in this study, even among those with frequent symptoms.
El-Serag
Hashem B
HB
Section of Gastroenterology, Houston Department of Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA. hasheme@bcm.tmc.edu
Petersen
Nancy J
NJ
Carter
Junaia
J
Graham
David Y
DY
Richardson
Peter
P
Genta
Robert M
RM
Rabeneck
Linda
L
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000208:ethnology / Q000473:pathology; D005260:Female; D005756:Gastritis / Q000208:ethnology / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000208:ethnology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*