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


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.
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Duowu
D
Zou
Jia
J
He
Xiuqiang
X
Ma
Jie
J
Chen
Yanfang
Y
Gong
Xiaohua
X
Man
Li
L
Gao
Rui
R
Wang
Yanfang
Y
Zhao
Xiaoyan
X
Yan
Wenbin
W
Liu
Börje
B
Wernersson
Saga
S
Johansson
John
J
Dent
Joseph J
JJ
Sung
Zhaoshen
Z
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D004724:Endoscopy; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006356:Heartburn; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000453:epidemiology; D006801:Humans; D057045:Laryngopharyngeal Reflux; D016015:Logistic Models; D008297:Male; D008679:Metaplasia / Q000453:epidemiology; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology; D015995:Prevalence; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult