Prevalence, clinical spectrum and atypical symptoms of gastro-oesophageal reflux in Argentina: A nationwide population-based study

Department of Gastroenterology, Hospital Nacional Prof. Dr Alejandro Posadas, El Palomar, Buenos Aires, Argentina.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 08/2005; 22(4):331-42. DOI: 10.1111/j.1365-2036.2005.02565.x
Source: PubMed

ABSTRACT Population-based data on gastro-oesophageal reflux in Latin America are lacking.
To assess gastro-oesophageal reflux symptom prevalence, clinical spectrum and association with the atypical symptoms in our country.
Gastro-oesophageal reflux self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-80 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census.
The overall prevalence of any typical gastro-oesophageal reflux symptom experienced in the previous year was 61.2% (95% CI, 57.9-64.6), the prevalence of frequent gastro-oesophageal reflux symptoms was 23.0% (95% CI, 20.1-25.9) and the prevalence of gastro-oesophageal reflux disease was 11.9% (95% CI, 9.6-14.1). Frequent gastro-oesophageal reflux symptoms were associated with dysphagia (OR 2.12, 95% CI, 1.27-3.54, P < 0.01), globus (OR 2.22, 95% CI, 1.35-3.66, P < 0.01) and non-cardiac chest pain (OR 1.55, 95% CI, 1.04-2.31, P < 0.05).
In Argentina, typical symptoms of gastro-oesophageal reflux are highly prevalent at the national level, and frequent gastro-oesophageal reflux symptoms are significantly associated with dysphagia, globus and non-cardiac chest pain.

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Available from: Graciela Salis, May 14, 2015
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    • "In 2009, GERD was the most common physician diagnosis for GI disorders in outpatient clinic visits in the United States and responsible for 8.9 million physician visits.6 Reports from many other populations have shown a high prevalence of GERD or an increase in the prevalence in recent years.7-11 Some of those with GERD symptoms may develop Barrett’s esophagus, which can lead to esophageal adenocarcinoma (EAC); however, a recent multicenter follow-up study of individuals with Barrett’s esophagus have shown that the risk of this transformation is small (<0.5% per year).12 "
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    ABSTRACT: BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease (GERD) and mortality at the general population level and they have shown mixed results. This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran. METHODS Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study (GCS). We identified 3107 deaths (including 1146 circulatory and 470 cancer-related) with an average follow-up of 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for multiple potential confounders. RESULTS Severe daily symptoms (defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants) were associated with cancer mortality (HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affect overall mortality. Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms. CONCLUSION We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality.
    Gastroenterology 04/2014; 6(2):65-80. DOI:10.1016/S0016-5085(14)63119-X · 16.72 Impact Factor
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    • "Typical reflux symptoms were found to be significantly and independently associated with the presence of NCCP. The prevalence of NCCP among patients with frequent and no reflux symptoms was 37.6% and 12.2%, respectively.5 "
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    ABSTRACT: In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux disease (GERD) is the commonest cause and ambulatory pH is of great value in identifying these patients. However, parameters in the context of predicting therapeutic response are still unknown. By extending the monitoring period, we could better evaluate the best evidence for GERD association. Our aims were (1) to compare the outcomes of 48-hour pH monitoring to 24-hour and (2) to determine whether objective parameters could predict the treatment success in patients with NCCP using Bravo pH system. Pathological esophageal acid reflux (PEAR) and positive symptom index (SI) were calculated after 24-hour and compared to the 48-hour study. Evidence suggestive of GERD diagnosis was considered if PEAR and/or SI (+) were present on each different day. After pH study, all patients received proton pump inhibitor twice a day for 4 weeks. Treatment success was determined at the end of therapy. Thirty-two patients with NCCP participated. GERD was identified in 20 (62.5%) patients; 17 (53.1%) had PEAR, 3 (9.4%) SI (+) and 7 (22%) both. Twelve (41%) patients exhibited PEAR values on day 1, while 17 after 2 days; a 12.1% gain. SI (+) was found in 6 patients (18.8%) on day 1 and in 4 more on day 2, a gain of 12.5%. Significantly higher proportion of patients with GERD indicators showed improvement compared to those without (90% vs 16.7%, P < 0.005). In patients with NCCP, 48-hour pH measurement identified GERD as the cause of NCCP with an increased yield by almost 12% compared to 12 hours. Objective GERD parameters could predict response to antireflux therapy.
    Journal of neurogastroenterology and motility 04/2012; 18(2):169-73. DOI:10.5056/jnm.2012.18.2.169 · 2.30 Impact Factor
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    • "Although females with NCCP tend to consult healthcare providers more often than men, the disorder affects both sexes equally.17,19,21 Additionally, females are more likely to present to hospital emergency departments with NCCP than males, but there are no sex differences regarding chest pain intensity.23 "
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    ABSTRACT: Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. However, despite its chronic nature, noncardiac chest pain has no impact on patients' mortality. The main underlying mechanisms include gastroesophageal reflux, esophageal dysmotility and esophageal hypersensitivity. Gastroesophageal reflux disease is likely the most common cause of noncardiac chest pain. Esophageal dysmotility affects only the minority of noncardiac chest pain patients. Esophageal hypersensitivity may be present in non-GERD-related noncardiac chest pain patients regardless if esophageal dysmotility is present or absent. Psychological co-morbidities such as panic disorder, anxiety, and depression are also common in noncardiac chest pain patients and often modulate patients' perception of disease severity.
    Journal of neurogastroenterology and motility 04/2011; 17(2):110-23. DOI:10.5056/jnm.2011.17.2.110 · 2.30 Impact Factor
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