title: Systematic review: patterns of reflux-induced symptoms and esophageal endoscopic findings in large-scale surveys.
abstract: OBJECTIVE
  This systematic review assesses findings of endoscopic surveys in the general population with regard to gastroesophageal reflux disease (GERD).
  
  
  METHODS
  Systematic searches were conducted in PubMed and EMBASE. Authors were contacted for additional, unpublished data.
  
  
  RESULTS
  Data on 61,281 individuals were included from 3 general population studies (Kalixanda study [Sweden], Loiano-Monghidoro study [Italy], SILC study [China]) and 8 health-check studies (Japan, n = 1; China, n = 1; Taiwan, n = 4; Korea, n = 2). The prevalence of reflux esophagitis was 15.5% (Kalixanda), 11.8% (Loiano-Monghidoro), and 6.4% (SILC); it ranged from 3.4% to 8.5% in health-check studies in Japan, China, and Korea (n = 4), but was higher (mean, 15.6%; range, 9.0%-24.6%; n = 4) in Taiwan. Hiatus hernia prevalence was 23.9% (Kalixanda), 43.0% (Loiano-Monghidoro), and 0.7% (SILC), and 0.8%-19.5% in health-check studies (n = 7). For endoscopically suspected esophageal metaplasia (ESEM), the prevalence was 10.3% (Kalixanda), 3.6% (Loiano-Monghidoro), and 1.8% (SILC), and 0.0%-3.4% in health-check studies (n = 4). The prevalence of reflux esophagitis among individuals without symptom-defined GERD was 12.1% (Kalixanda), 8.6% (Loiano-Monghidoro), 6.1% (SILC), and 1.6%-22.8% (health-check studies; n = 6). For individuals without symptom-defined GERD, the prevalence of ESEM was 9.4% (Kalixanda), 2.8% (Loiano-Monghidoro), and 1.8% (SILC).
  
  
  CONCLUSIONS
  The prevalence of reflux esophagitis is higher in Sweden and Italy than in China, Korea, and Japan, but is within the range reported in Taiwan. Hiatus hernia and ESEM are generally more prevalent in Europe than in Asia. A considerable proportion of individuals without symptom-defined GERD has reflux esophagitis or ESEM.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA 5000, Australia. john.dent@health.sa.gov.au
authors.forename: John
authors.initials: J
authors.lastname: Dent
authors.forename: Anja
authors.initials: A
authors.lastname: Becher
authors.forename: Joseph
authors.initials: J
authors.lastname: Sung
authors.forename: Duowu
authors.initials: D
authors.lastname: Zou
authors.forename: Lars
authors.initials: L
authors.lastname: Agréus
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans