title: Population based study to assess prevalence and risk factors of gastroesophageal reflux disease in a high altitude area.
abstract: OBJECTIVE
  We did a population-based cross-sectional study to investigate the prevalence and risk factors of gastroesophageal reflux disease (GERD) in a high altitude area.
  
  
  METHODS
  An observational study using a validated questionnaire consisting of demographic, lifestyle and dietary characteristics was administered in an interview based format by two clinicians on a sample of adult population residing in urban area and rural high altitude areas of Ladakh. Presence of GERD was defined as a score of ≥4 using a previously validated symptom score based on the severity and frequency of heartburn and regurgitation. Other factors studied were body mass index (BMI), oxygen saturation levels by pulse oximetry and serum lipid profile. A multivariate analysis was done to find out risk factors for symptomatic GERD.
  
  
  RESULTS
  Of the 905 subjects analyzed, there were 399 (44.1%) men; 469 (51.8%) were from rural background and 722 (79.8%) lived in areas 3,000 m above sea level. Symptomatic GERD was present in 169 (18.7%) subjects. Regurgitation occurred once a week in 34.8% and heartburn occurred in 42.9% of subjects. Sixteen (9.5%) had moderate-severe disease activity while 153 (90.5%) had mild disease. Three hundred and eighty-eight (42.7%) and 315 (34.8%) subjects had symptom of heartburn and regurgitation (at least once a week), respectively. On multivariate analysis, risk factors for GERD were age ≤50 years (OR: 1.508, 95% CI: 1.028-2.213), sedentary lifestyle (OR: 2.78, 95% CI: 1.016-7.638), lower intake of salt tea (OR: 1.663, 95% CI: 1.014-2.726); whereas the protective factors were no intake of meat (OR: 0.841, 95% CI: 0.715-0.990), intake of fresh fruits ≥1/week (OR: 0.631, 95% CI: 0.409-0.973), and serum LDL ≤150 mg/dL (OR: 0.435, 95% CI: 0.218-0.868).
  
  
  CONCLUSIONS
  This population-based study in a high altitude area in India suggests a high prevalence (18.7%) of GERD. A younger age group, sedentary lifestyle, serum LDL >150 mg/dL, high consumption of meat, low consumption of salted tea and low consumption of fresh fruits were significant risk factors for development of GERD.
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110 029, India.
authors.forename: Sushil
authors.initials: S
authors.lastname: Kumar
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sharma
authors.forename: Tsering
authors.initials: T
authors.lastname: Norboo
authors.forename: Diskit
authors.initials: D
authors.lastname: Dolma
authors.forename: Angchuk
authors.initials: A
authors.lastname: Norboo
authors.forename: Tsering
authors.initials: T
authors.lastname: Stobdan
authors.forename: S
authors.initials: S
authors.lastname: Rohatgi
authors.forename: K
authors.initials: K
authors.lastname: Munot
authors.forename: Vineet
authors.initials: V
authors.lastname: Ahuja
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000531:Altitude; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult