Prevalence of Symptoms and Use of Medication for Gastroesophageal Reflux in an Australian Community
ABSTRACT Gastroesophageal reflux disease is common in Western societies, although the prevalence of reflux symptoms in the community is not well described. In this study we determined the prevalence of symptoms of gastroesophageal reflux and other "esophageal" symptoms, and the consumption of medication for reflux in an Australian community.
A population sample designed to accurately reflect the characteristics of the population aged 15 years or older in the State of South Australia was studied. Demographic data; symptoms specific to reflux, dysphagia, and abdominal bloating; and the consumption of antireflux medication were determined in a face-to-face interview. The frequency and severity of heartburn and dysphagia were assessed with analog scales.
A total of 2,973 people (age range: 15-95 years) were interviewed between September and December 2006. Approximately half experienced the symptom of heartburn; 21.2% experienced heartburn at least once a month, and 12.4% described frequent symptoms of heartburn (at least a few times each week). Of those with heartburn, 25.0% graded it as moderate or severe, 10.9% reported some dysphagia for solid foods, and 6.9% reported dysphagia for liquids. 3.7% described dysphagia for solids at least once a month. Abdominal bloating was reported by 48.2%. 16.9% were taking medications for reflux symptoms (10.1% proton pump inhibitors, 1.2% H2-receptor antagonists, 2.1% simple antacids, 3.4% alternative medications). Heartburn was more common in individuals who consumed medication. There were significant associations between heartburn and bloating, and between heartburn and dysphagia.
Symptoms of gastroesophageal reflux and the use of medications to treat such symptoms are very common in the community of South Australia. Nearly 1 in 7 people over the age of 15 consume medication for the treatment of symptoms of reflux.
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ABSTRACT: Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma; the incidence of this cancer is rapidly increasing in Western populations. However, few population-based studies of BE have been conducted, so little is known about potentially modifiable causes of this disease. The study included patients with newly diagnosed BE, confirmed by histology and categorized as simple BE (without dysplasia, n = 285) or dysplastic BE (with dysplasia, n = 108). We recruited 2 separate control groups: endoscopy patients with acute inflammatory changes (inflammation controls, n = 313) and population controls sampled from a population register (n = 644). Data were collected through standardized questionnaires and telephone interviews. We fit logistic regression models to calculate odds ratios (ORs) for BE associated with salient exposures by using each set of controls. Relative to never smokers, risks of simple BE were significantly higher among former smokers (OR, 2.39; 95% confidence interval, 1.59-3.60) and current smokers (OR, 2.41; 95% confidence interval, 1.39-4.17), compared with population controls. Smoking conferred more than a 4-fold increase in risk for dysplastic BE; this increase in risk remained long after individuals quit smoking. We found no conclusive association between BE and passive smoking and no evidence of independent associations between body mass index (BMI) and simple BE or dysplastic BE, after adjusting for reflux and other factors. Analyses with inflammation controls produced qualitatively similar risk estimates for smoking and BMI to those obtained for population controls, but they were markedly attenuated for reflux, as expected. Current and past smoking significantly increases risk for BE, but BMI does not, after adjustment for the effect of reflux.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2009; 7(8):840-8. DOI:10.1016/j.cgh.2009.04.018 · 6.53 Impact Factor
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ABSTRACT: The prevalence of gastroesophageal reflux symptoms (GERS) in the population is high; however, data on long-term follow-up and incidence of GERS in the population are sparse. This study describes the long-term natural history of GERS, the related health-care use, and quality of life in a population followed up for 5 years. A total of 10,000 randomly selected inhabitants, 40-65 years old, received, as a part of a controlled trial of Helicobacter pylori screening and treatment (control group), a mailed questionnaire regarding demographic data, gastrointestinal symptoms (the Gastrointestinal Symptom Rating Scale (GSRS)), and quality of life (the Short-Form 36-Item Health Survey (SF-36)) at inclusion and after 5 years. GERS was defined as a mean score > or =2 in the reflux dimension in the GSRS. Information on use of health-care resources was drawn from the questionnaires and registers. In all, 6,781 individuals answered the first questionnaire and 5-year symptom data were complete for 5,578 (82.3%) of them. The mean age at inclusion was 52.4 years, 48% were men. At inclusion, 22% reported GERS. During follow-up, symptoms resolved in 43%, of whom 10% received acid inhibitory treatment at 5-year follow-up. The incidence of GERS was 2.2% per year. Health-care use during follow-up was significantly higher in individuals with GERS at baseline than in individuals without GERS. Quality of life at 5-year follow-up was lower in individuals with GERS at inclusion than in individuals without GERS at inclusion. GERS are prevalent, long lasting, and associated with an impaired quality of life and substantial health-care use.The American Journal of Gastroenterology 08/2009; 104(10):2394-403. DOI:10.1038/ajg.2009.391 · 9.21 Impact Factor
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ABSTRACT: Objective: To measure the extent to which risks of oesophageal cancers associated with gastro-oesophageal reflux (GOR) are modified by common factors including smoking, non-steroidal anti-inflammatory drugs (NSAIDs) and acid suppressant medications. Design and setting: Population-based case-control study. Participants: Cases were patients with oesophageal (OAC; n = 365) or gastro-oesophageal junction (GOJAC; n = 426) adenocarcinomas, or squamous cell carcinomas (OSCC; n = 303). Controls were sampled from a population register (n = 1580). Main outcome measure: Odds ratio and 95% confidence interval. Results: Frequent (at least weekly) symptoms of GOR were associated with significant 6.4-fold, 4.6-fold and 2.2-fold increased risks of OAC, GOJAC and OSCC, respectively. Under models examining effects of combined exposure, patients with frequent GOR symptoms who were also heavy smokers had markedly higher OAC risks (OR = 12.3, 95% CI 6.3 to 24.0) than those with frequent GOR who did not smoke (OR = 6.8, 95% CI 3.6 to 12.9). Similar patterns were observed for GOJAC and OSCC. Among people with frequent GOR symptoms, regular use of aspirin/NSAIDs was associated with almost two-thirds lower OAC risks (OR = 4.8, 95% CI 2.5 to 9.2) than non-users (13.9, 95% CI 6.5 to 30.0). In contrast, among those with frequent GOR symptoms, users of acid suppressants had similar OAC risks (OR 7.8, 95% CI 5.2 to 11.8) to non-users (OR 5.3, 95% CI 3.2 to 9.0). Conclusions: People experiencing frequent GOR symptoms have markedly increased risks of OAC and GOJAC, and this effect may be greater amongst smokers. Use of aspirin and NSAIDs, but not acid suppressants, significantly reduced the risks of oesophageal cancers associated with GOR.Gut 10/2009; 59(1). DOI:10.1136/gut.2009.190827 · 13.32 Impact Factor