ArticlePDF AvailableLiterature Review

Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal Reflux Disease in Canada: Incidence, Prevalence, and Direct and Indirect Economic Impact

Authors:

Abstract and Figures

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease - a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition).
Content may be subject to copyright.
Can J Gastroenterol Vol 24 No 7 July 2010 431
Canadian Digestive Health Foundation Public Impact
Series: Gastroesophageal reflux disease in Canada:
Incidence, prevalence, and direct and indirect
economic impact
Richard N Fedorak MD FRCPC1, Sander Veldhuyzen van Zanten MD FRCPC1, Ron Bridges MD FRCPC2
1Division of Gastroenterology, University of Alberta, Edmonton; 2Division of Gastroenterology, University of Calgary, Calgary, Alberta
Correspondence: Dr Richard N Fedorak, Division of Gastroenterology, University of Alberta, 2-14A Zeidler Building,
Edmonton, Alberta T6G 2X8. Telephone 780-492-6941, fax 780-492-8121, e-mail richard.fedorak@ualberta.ca
Received for publication May 21, 2010. Accepted May 24, 2010
The Canadian Digestive Health Foundation (CDHF)
launched a scientific project to define the incidence, preva-
lence, mortality and economic impact of digestive disorders
across Canada. Detailed information regarding 19 digestive
disorders was compiled through systematic reviews, government
documents and websites. This information was published as
“Establishing Digestive Health as a Priority for Canadians, The
Canadian Digestive Health Foundation National Digestive
Disorders Prevalence and Impact Study Report”, and released to
the press and the government in late 2009 (www.CDHF.ca).
The CDHF Public Impact Series presents a full compilation of
the available statistics regarding the impact of digestive disor-
ders in Canada.
Gastroesophageal reflux disease (GERD) is a condition that
develops when the reflux of stomach contents causes trouble-
some symptoms and/or complications (Montreal definition).
The most frequent complication is inflammation leading to
esophagitis, stricture, Barrett’s esophagus and adenocarcinoma
(Table 1). Most people consider symptoms troublesome if they
are mild and occur more than once a week, or at least once a
week for moderate to severe symptoms. Many individuals self-
medicate with over-the-counter medications such as antacids
(1). Although the cause or origin of this chronic disease is not
well understood, there are certain risk factors associated with
GERD development (Table 2). It has been well documented
that individuals with untreated GERD experience a significant
decrease in their quality of life and have a higher risk for
developing serious complications.
The Canadian Association of Gastroenterology has created
an evidence-based practice guideline for the diagnosis and
treatment of GERD (2). Initial diagnosis of GERD is made if
the symptomatic patient responds to antacid therapies such
as H2-receptor antagonists or the more effective – but more
costly – proton pump inhibitors. Patients who experience
ORIGINAL ARTICLE
©2010 Pulsus Group Inc. All rights reserved
RN Fedorak, S Veldhuyzen van Zanten, R Bridges. Canadian
Digestive Health Foundation Public Impact Series:
Gastroesophageal reflux disease in Canada: Incidence,
prevalence, and direct and indirect economic impact. Can J
Gastroenterol 2010;24(7):431-434.
The Canadian Digestive Health Foundation initiated a scientific pro-
gram to assess the incidence, prevalence, mortality and economic
impact of digestive disorders across Canada. The current article pres-
ents the updated findings from the study concerning gastroesophageal
reflux disease – a condition that develops when the reflux of stomach
contents causes troublesome symptoms and/or complications (Montreal
definition).
Key Words: Acid reflux; Chronic disease; Gastroesophageal reflux
disease; GERD; Heartburn; Pyrosis
Le reflux gastro-œsphagien au Canada : Incidence, prévalence et
impact économique direct et indirect selon la série Impact public
de la Fondation canadienne pour la promotion de la santé
digestive
La Fondation canadienne pour la promotion de la santé digestive a mis sur
pied un programme scientifique dans le but de mesurer l’incidence, la
prévalence, la mortalité et l’impact économique associés aux maladies
digestives au Canada. Cet article présente les conclusions mises à jour de
l’étude sur le reflux gastro-œsophagien, une maladie caractérisée par le
reflux du contenu gastrique et qui occasionne des symptômes et/ou des
complications ennuyeux (d’après la définition de Montréal).
TABLE 1
Overview of gastroesophageal reflux disease
Common symptoms Uncommon symptoms Complications
Heartburn Hoarseness and
sore throat
Erosive esophagitis
Regurgitation Esophageal stricture
Localized or diffuse or
retrosternal pain or
epigastric pain
Difficulties swallowing Ulceration and bleeding
Asthma Barrett’s epithelium
Sinusitis Esophageal
adenocarcinoma
Sleep disturbance Nausea
Postprandial fullness Vomiting Upper respiratory
complaints
(eg, wheezing, chronic
coughing
or throat clearing)
Upper abdominal
distension
Early satiety
Fedorak et al
Can J Gastroenterol Vol 24 No 7 July 2010432
no symptom improvements are commonly referred to gastro-
enterologists for testing to eliminate other possible causes. A
diagnosis of refractory GERD is made if no other causes are
identified and a patient’s symptoms persist in spite of proton
pump inhibitor dose escalation to twice daily; typically, this
represents 19% to 32% of GERD patients (3,4). Surgical inter-
ventions (eg, Nissen fundoplication) can be associated with
significant symptom improvements for adults with refractory or
moderate to severe GERD.
Increased awareness of GERD is necessary to improve the
health of Canadians who may be suffering in silence. Much
information has already been obtained in other western cul-
tures, which can be placed into a Canadian context; to date,
however, this has yet to be completed. By understanding the
epidemiological and economic impact of GERD on Canadians
and our society, health care professionals, policy makers and
the public at large can take the next steps in developing a dis-
ease management priority list.
METHODS
A systematic literature review was conducted to retrieve
peer-reviewed, English language scholarly articles using the
PubMed, Medline, EMBASE and Scopus databases. The
search terms “reflux disease”, “GERD” and “GORD” were
used, with specific focus on epidemiological and economic
studies from developed countries. Additional information was
retrieved from government sources, the WHO and not-for-
profit organizations.
RESULTS
Incidence (Table 3)
Only two longitudinal studies (5,6) examining the incidence
of GERD in adults have been conducted. The first (5) was
conducted in the United Kingdom (UK) and relied on first-
time physician diagnoses of GERD, esophagitis, esophageal
inflammation or heartburn as recorded in the General Practice
Research Database in 1996. The authors found that the annual
incidence of GERD was 4.5 per 1000 person-years (95% CI
4.4 to 4.7). The second study (6) used the Medicaid database
for the state of Georgia (USA) to identify new cases of GERD
based on filled prescriptions. The incidence of 5.4 cases per
1000 person-years was very similar to the incidence reported in
the UK study. It should be noted that both studies only captured
the portion of GERD sufferers who sought medical assistance
for their symptoms, implying that this figure is much larger, but
it is unclear by how much. There are no prospective published
incidence studies of GERD in the Canadian population.
Extrapolating the UK and USA incidence rates, and using
an estimate population of 34 million within Canada, every
year, a minimum of 170,000 individuals will be newly diag-
nosed with GERD. Importantly, the peak age distribution of
GERD is 60 to 70 years, indicating that the incidence rate is
tightly linked with age in Western populations (7). Between
2010 and 2040, the proportion of Canadian seniors is projected
to nearly double, suggesting that the GERD incidence rate will
likely increase sharply rather than stabilize or decrease (8).
Using an American administrative claims database (9),
the diagnosis rate of pediatric GERD or acid-related disease
was 0.6% to 1.0% per year. Between 1999 and 2005, the inci-
dence rate of newly diagnosed GERD in children younger
than one year of age increased sharply from 3.4% to 12.3%. This
increase was largely attributed to increased awareness in addi-
tion to cases of either overdiagnosis or misdiagnosis of eosino-
philic esophagitis. Because this study’s findings corroborate
those from another (10) investigating prescription acid sup-
pression therapy in pediatrics and corresponds to the period in
which childhood obesity has leapt dramatically, it is likely that
these findings are not artefacts of either poor study design or
interpretation.
Sixteen per cent of the Canadian population of 34 million
are zero to 14 years of age and, at an incidence rate of 1%,
56,000 Canadian children are projected to be newly diagnosed
with GERD each year (11). The majority of these patients will
be younger than one year of age. Both prescription medicines
and over-the-counter antacids – many of which are in a solid
form unsuitable for the very young and for which there is neg-
ligible evidence supporting their efficacy in placebo-controlled
trials (9) – are not approved for use in children.
Prevalence (Table 3)
GERD is a chronic disease that can last for up to 18 years (12).
Between 34% and 41% of GERD patients recall experiencing
GERD-like symptoms for more than 10 years before diagnosis
(12). This long-term cumulative effect results in an increasing
patient population year after year. In Western countries, the
prevalence range for GERD is 10% to 20% of the population
(3.4 million to 6.8 million Canadians). A uniquely Canadian
consideration is the long life expectancy relative to other coun-
tries. The combination of long life expectancy and an aging
population will increase the overall number of GERD patients
in the years to come (8,13). There are no data that support sex
predominance with regard to GERD.
Pediatric GERD patients have been documented, with most
cases spontaneously resolving within a few months or years
TABLE 2
Risk factors for developing gastroesophageal reflux
disease
Obesity (24)
Smoking (25)
Age (24)
Parental or family history of gastrointestinal diseases (24)
Esophageal stricture (24)
High-cholesterol diet (25)
Lung transplantation (26)
Cystic fibrosis (27)
TABLE 3
Canadian incidence, prevalence and economic impact of
gastroesophageal reflux disease
Published data (reference) Canadian exposures*
Incidence
Adult 4.5 – 5.4/1000 person-years (5,6) 170,000 per year (19)
Pediatric 9 – 10/1000 person-years (9) 56,000 per year (19)
Prevalence 10% – 20% (11) 3.4 – 6.8 million
persons (19)
Direct costs $52,235,910 per year (16)
Indirect costs ~6.7 h per week lost work (20)
*Extrapolated to a population of 34 million
CDHF Impact Series: GERD in Canada
Can J Gastroenterol Vol 24 No 7 July 2010 433
after birth. Surgery is not recommended, especially because
proton pump inhibitors are well tolerated in pediatric patients.
The treatment goal is to eliminate GERD symptoms, then to
step down therapy to an ‘as-required’ basis (9).
Mortality
Because GERD is often not the primary cause of death but a
secondary or underlying condition, its role is often not
recorded, although it may be a significant contributor. Between
2000 and 2005, there was an annual mean of 65 mortalities
caused primarily by GERD (Figure 1) (14). As with incidence
and prevalence, there is no apparent sex discrimination.
Economics
Direct costs: In 2004/2005, the Canadian health care system
spent a mean of $6,915 per patient for the 7554 patients who had
a primary diagnosis of diseases of the esophagus and associated
complications, for a total of $52,235,910 (15).
In Canada, the first H2-receptor antagonist was licensed for
sale over the counter in June 1996 (16). Although not as
effective as proton-pump inhibitors (17), GERD patients can
self-medicate with H2-receptor antagonists; however, they
incur considerable personal expense and risk the development
of GERD-related health complications (16). Proton pump
inhibitor therapy has grossed in excess of $10 billion in global
sales since its introduction in 1988 (18). Worldwide, there
have been more than 720 million prescriptions written for pro-
ton pump inhibitor therapy (18). In 2004, there were 12.4 mil-
lion prescriptions for proton pump inhibitors – as prescribed by
MDs (19) (Figure 2). Canadian cost estimates for a 28-day sup-
ply of proton pump inhibitor therapy range from $40 to $70
(19).
Indirect costs
In 2005, a Canadian study (20) of medically diagnosed GERD
patients (n=217) with moderate-to-severe symptoms was con-
ducted to ascertain the impact of the disease. Of the 173 patients
who were employed, 6.7 h of work time was lost each week due
to GERD symptoms (16% lost work time, 95% CI 12.9% to
18.8%). Activity impairment also affected as much as 21% of
nonwork-related activities (95% CI 18.0% to 24.0%). This is
explained by the significantly lower scores for the physical and
mental component summaries of the Medical Outcomes Study
Short Form-36 Health Survey of the cohort compared with the
Canadian population (P<0.001). Relative to other diseases,
the GERD cohort had physical scores similar to individuals
with clinical depression or hypertension, while mental scores
were significantly worse (P<0.001) than hypertensive or dia-
betic patients.
The frequency of GERD patients who develop cancer from
associated dysplastic Barrett’s epithelium is low, suggesting that
routine endoscopic screening of this population group is not war-
ranted (21). In turn, this represents a considerable cost savings
to a health care insurer because a single endoscopy procedure
costs $575 (Ambulatory care classification system 28.1) (22).
For pediatric patients, GERD can be successfully treated
with proton pump inhibitors and, in severe cases, surgical
intervention may be required (17,23); however, surgery of this
nature on young patients is associated with comorbidity and
failure.
At any age, GERD diagnosis represents a considerable long-
term expense for the health insurer and the patient; however,
prompt diagnosis in the very young is essential to reduce health
care burdens and reduce the need for surgical interventions (17).
Figure 1) Gastroesophageal reflux disease-related mortalities per
year categorized according to age group
Figure 2) Retail market ($) for over-the-counter indigestion and
heartburn remedies in Canada according to year
REFERENCES
1. Frank L, Kleinman L, Ganoczy D, et al. Upper gastrointestinal
symptoms in North America: Prevalence and relationship to
healthcare utilization and quality of life. Dig Dis Sci
2000;45:809-18.
2. Armstrong D, Marshall JK, Chiba N, et al. Canadian Consensus
Conference on the management of gastroesophageal reflux disease
in adults – update 2004. Can J Gastroenterol 2005;19:15-35.
3. Bardhan KD. The role of proton pump inhibitors in the treatment
of gastro-oesophageal reflux disease. Aliment Pharmacol Ther
1995;9(Suppl 1):15-25.
4. Martinez SD, Malagon IB, Garewal HS, Cui H, Fass R.
Non-erosive reflux disease (NERD) – acid reflux and symptom
patterns. Aliment Pharmacol Ther 2003;17:537-45.
5. Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S,
Dent J. Comparison of gastro-oesophageal reflux disease and
heartburn diagnoses in UK primary care. Curr Med Res Opin
2006;22:1661-8.
6. Kotzan J, Wade W, Yu HH. Assessing NSAID prescription use as a
predisposing factor for gastroesophageal reflux disease in a Medicaid
population. Pharm Res 2001;18:1367-72.
7. Heading RC. Epidemiology of oesophageal reflux disease.
Scand J Gastroenterol Suppl 1989;168:33-7.
8. Belanger A, Martel L, Caron-Malenfant E. Population projections
for Canada, Provinces and Territories, 2005-2031. Statistics Canada
(91-520-XIE), 2005.
9. Nelson SP, Kothari S, Wu EQ, Beaulieu N, McHale JM,
Dabbous OH. Pediatric gastroesophageal reflux disease and
acid-related conditions: Trends in incidence of diagnosis and acid
suppression therapy. J Med Econ 2009;12:348-55.
Fedorak et al
Can J Gastroenterol Vol 24 No 7 July 2010434
10. Kothari S, Nelson SP, Wu EQ, Beaulieu N, McHale JM,
Dabbous OH. Healthcare costs of GERD and acid-related
conditions in pediatric patients, with comparison between
histamine-2 receptor antagonists and proton pump inhibitors.
Curr Med Res Opin 2009;25:2703-9.
11. Statistics Canada. Population by sex and age group, CANSIM,
Table 051-0001. <http://www40.statcan.gc.ca/l01/cst01/demo10a-
eng.htm> (Accessed on May 14, 2010).
12. Armstrong D. Systematic review: Persistence and severity in gastro-
oesophageal reflux disease. Aliment Pharmacol Ther 2008;28:841-53.
13. Organisation for Economic Co-operation and Development
(OECD). OECD Health Data 2009. <http://www.oecd.org>
(Accessed on May 14, 2010).
14. Statistics Canada. CANSIM – Table 102-0531 – Deaths, by cause,
Chapter XI: Diseases of the digestive system (K00 to K93), age
group and sex, Canada, annual (2000-2005). <http://cansim2.
statcan.gc.ca> (Accessed on May 14, 2010).
15. Canadian Institute for Health Information. The Cost of Hospital
Stays: Why Costs Vary. Ottawa: CIHI Press, 2008.
16. Bursey F, Crowley M, Janes C, Turner CJ. Cost analysis of a
provincial drug program to guide the treatment of upper
gastrointestinal disorders. CMAJ 2000;162:817-23.
17. Gold BD. Review article: Epidemiology and management of
gastro-oesophageal reflux in children. Aliment Pharmacol Ther
2004;19(Suppl 1):22-7.
18. Raghunath AS, O’Morain C, McLoughlin RC.
Review article: The long-term use of proton-pump inhibitors.
Aliment Pharmacol Ther 2005;22:55-63.
19. Canadian Agency for Drugs and Technologies in Health. Proton
pump inhibitors. <http://www.cadth.ca/index.php/en/compus/ppis>
(Accessed on May 14, 2010).
20. El-Dika S, Guyatt GH, Armstrong D, et al. The impact of illness
in patients with moderate to severe gastro-esophageal reflux disease.
BMC Gastroenterol 2005;5:23.
21. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett
esophagus, and esophageal cancer: Scientific review.
JAMA 2002;287:1972-81.
22. Health Authority Funding and Financial Accountability.
Health Costing in Alberta 2006 Annual Report. 2007. Alberta
Health and Wellness. <http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-
lcs/2006-cha-lcs-ar-ra/ab-eng.php> (Accessed on June 7, 2010).
23. Hassall E. Decisions in diagnosing and managing chronic
gastroesophageal reflux disease in children. J Pediatr
2005;146:S3-12.
24. Dent J, El-Serag HB, Wallander MA, Johansson S.
Epidemiology of gastro-oesophageal reflux disease: A systematic
review. Gut 2005;54:710-7.
25. Eslick GD, Talley NJ. Gastroesophageal reflux disease (GERD):
Risk factors, and impact on quality of life – a population-based
study. J Clin Gastroenterol 2009;43:111-7.
26. Molina EJ, Short S, Monteiro G, Gaughan JP, Macha M.
Symptomatic gastroesophageal reflux disease after lung
transplantation. Gen Thorac Cardiovasc Surg 2009;57:647-53.
27. Blondeau K, Pauwels A, Dupont L, et al. Characteristics of
gastroesophageal reflux and potential risk of gastric content
aspiration in children with cystic fibrosis.
J Pediatr Gastroenterol Nutr 2010;50:161-6.
... Approximately 30,000 Canadians die from digestive disease annually [2]. Such disease burden has significant direct and indirect costs to the health care system [2][3][4][5][6][7] with direct healthcare costs for IBD estimated to exceed $28 billion by 2025 [5]. ...
... Approximately 30,000 Canadians die from digestive disease annually [2]. Such disease burden has significant direct and indirect costs to the health care system [2][3][4][5][6][7] with direct healthcare costs for IBD estimated to exceed $28 billion by 2025 [5]. ...
Article
Full-text available
Background Primary healthcare providers play a critical role in diagnosing and managing digestive disorders. Standardized clinical care guidelines have been developed, but with limited and inconsistent implementation. An evidence-based gastroenterology clinical care pathway (GUTLINK) has been proposed in one region of Canada; however, little is known in the medical literature about potential barriers to pathway implementation within primary care. We aimed to identify behavioral and environmental barriers and facilitators to implementation of evidence-based care pathways for undifferentiated lower gastrointestinal tract symptoms in primary care. Methods One-on-one semi-structured interviews were conducted with primary healthcare providers between September 2021 and May 2022. Interview script development was guided by the COM-B framework. Interviews were transcribed and data were analyzed using an inductive thematic analysis approach. Results A total of 15 primary healthcare provider interviews were conducted. Several key barriers to GUTLINK implementation were identified in all three domains of the COM-B framework. Key barriers included Capability (e.g., Physician Knowledge and Access to Allied Health), Opportunity (e.g., Access to diagnostic tools), and Motivation (e.g., Comfort with managing cases and optimism). Some of these barriers have not previously been identified in medical literature. Conclusions Evidence-based clinical care pathways have the potential to support access to quality gastroenterology care, yet primary healthcare providers in this study identified several barriers to implementation. Potential solutions exist at the individual and clinic levels (e.g., greater education, improved provider-specialist communication), but must be supported with systems-level changes (e.g., increased funding for gastrointestinal care and e-Health platforms) to support pathway implementation and improve quality of care.
... (5). The occurrence of potentially deadly consequences can be caused by GERD, even if the condition itself is not lethal (6). Based on the symptoms produced, it can be classified into two major types: erosive type, which is associated with esophageal mucosal damage, and non-erosive reflux disease, which encompasses symptoms lacking endoscopic indications of injury to the esophageal mucosa (7). ...
... Gastroesophageal reflux disease (GERD) is characterized by the reflux of abnormal stomach contents into the esophagus [1,2]. GERD symptoms are observed within 15-20% of adults residing in the United States; on the other hand, its prevalence ranges from 6.3% to 18.3% in Asian nations with roughly around 7.6-30% in the Indian population [3][4][5][6][7]. GERD encompasses erosive esophagitis (EO) and non-erosive reflux disease (NERD), with NERD accounting for the majority (70%) of GERD instances [8]. ...
Article
Full-text available
Introduction: Proton pump inhibitors (PPIs) regulate gastric acid reflux. Dexlansoprazole's efficacy in prolonging acid suppression compared to conventional PPIs and placebo requires evaluation. Methods: A prospective, randomized, placebo-controlled, five-way crossover pilot study was conducted on healthy volunteers comparing the potency of dexlansoprazole to conventional PPIs in which five patients were randomized into five treatment cohorts, including dexlansoprazole 60 mg, pantoprazole 40 mg, esomeprazole 40 mg, rabeprazole 20 mg, and placebo, assessing 24-hour intragastric pH using Z/pH Recorder (ZepHr®, Diversatek, Inc., Milwaukee, WI) and analyzing statistical differences via paired t-test. Results: Dexlansoprazole showed significantly longer durations with pH > 4.0 compared to placebo (P < 0.001) and all other PPIs (P < 0.05) over 24 hours. Although not significant in the first 0-12-hour period, dexlansoprazole maintained significantly higher pH levels in the last 12-24-hour period compared to pantoprazole (P = 0.001) and esomeprazole (P = 0.044) but not with rabeprazole (P = 0.075). Additionally, during the 24-hour pH monitoring measured at 30-minute intervals, dexlansoprazole (mean pH = 3.98 ± 0.11) consistently showed higher values than pantoprazole (mean pH = 3.48 ± 0.12), rabeprazole (mean pH = 3.66 ± 0.05), esomeprazole (mean pH = 3.66 ± 0.05), and placebo (mean pH = 2.52 ± 0.12), indicating its superior potency. Conclusion: Dexlansoprazole's dual-delayed release mechanism demonstrates superior acid suppression compared to traditional PPIs and placebo in this pilot study. Larger studies are needed to further evaluate its long-term efficacy and safety.
... (5). The occurrence of potentially deadly consequences can be caused by GERD, even if the condition itself is not lethal (6). Based on the symptoms produced, it can be classified into two major types: erosive type, which is associated with esophageal mucosal damage, and non-erosive reflux disease, which encompasses symptoms lacking endoscopic indications of injury to the esophageal mucosa (7). ...
Article
Full-text available
Gastroesophageal reflux disease (GERD) is a prevalent chronic disorder characterized by the backflow of acidic gastric contents into the esophagus due to lower esophageal sphincter (LES) dysfunction. This condition causes esophageal mucosal damage, leading to symptoms such as heartburn and chest pain, and is associated with increased risks of severe complications, including esophageal adenocarcinoma. Aims: To review the current state of GERD management and assess the potential of photochemical plant-based treatments as alternatives to conventional therapies. Methods: A comprehensive literature review was performed to describe the status of GERD in detail while focusing on the emerging role of plant-based therapies in GERD management. Results: Traditional treatments for GERD are effective but often come with side effects and limitations. Plant-based treatments, particularly those with photochemical properties, are potential African journal of gastroenterology and hepatology Al-Sulivany B et al.2024 257 complementary therapies. Preliminary data suggest these alternatives may improve symptom management and patient outcomes. Conclusions: While standard treatments for GERD are widely used, their limitations necessitate exploring alternative options. Photochemical plant-based therapies offer a promising, supplementary approach, pending further validation through research and clinical trials.
... Particularly noteworthy is the occurrence of GERD symptoms on a weekly basis among 15-20% of individuals in the United States. [3][4][5][6] In Asian regions, GERD's occurrence varies from 6.3% to 18.3%, signifying an escalating tendency relative to earlier reports. 7 GERD can be stratified into two categories: erosive oesophagitis (EO) and non-erosive reflux disease (NERD), with NERD constituting 70% of instances and EO accounting for the remaining 30%. ...
Article
Full-text available
Gastroesophageal reflux disease (GERD) remains prevalent in medical practice. Proton pump inhibitors (PPIs) are the primary treatment, yet limitations exist. Dexlansoprazole modified release (MR), an R-enantiomer of lansoprazole, offers high efficacy. Its dual release in the duodenum and small intestine yields two peak concentrations at different times (2- and 5-hours post-administration), ensuring the longest maintenance of drug concentration and proton pump inhibitory effect among all PPIs. Dexlansoprazole MR effectively heals erosive esophagitis, maintains healed esophageal mucosa, and controls NERD symptoms. It also improves nocturnal heartburn, GERD-related sleep disturbances, and bothersome regurgitation. Importantly, it maintains good plasma concentration regardless of food intake, enabling flexible dosing. Furthermore, it does not significantly affect clopidogrel metabolism or platelet inhibition, eliminating the need for dose adjustments when co-prescribed. This review highlights dexlansoprazole's unique attributes, pharmacokinetics, advantages, and safety in comparison to traditional PPIs.
... GI symptoms not only have an enormous impact on the quality of life, work, and daily activities of affected individuals, they 19:14 also impose substantial societal and economic costs [5]. These conditions are often under-recognized and remain untreated, which is concerning given their prevalence and the associated significant health and economic implications [6][7][8]. ...
Article
Full-text available
Background There is a paucity of studies reporting the presence of systemic symptoms and micronutrient deficiency in patients with chronic urticaria, and these data are lacking in a Canadian population. Objective To report the prevalence of gastrointestinal symptoms and vitamin B12 (cobalamin) deficiency in a Canadian patient population diagnosed with chronic urticaria. Methods A retrospective chart review of 100 adult patients with chronic urticaria was conducted. Demographic characteristics, medications, presence of gastrointestinal symptoms, and laboratory findings were abstracted from electronic medical records. Results Seventy percent of patients with chronic urticaria reported experiencing gastrointestinal symptoms. The most common symptom identified was gastroesophageal reflux (42%). Vitamin B12 (cobalamin) deficiency, defined as serum vitamin B12 level ≤ 250 pmol/L, was identified in 31.7% of the patients. Among those patients with urticaria and vitamin B12, 68% reported gastrointestinal symptoms. Conclusions This is the first study to provide data on the high prevalence of gastrointestinal symptoms and vitamin B12 (cobalamin) deficiency in a Canadian population diagnosed with chronic urticaria. Early recognition and management of systemic symptoms and micronutrient deficiency may lead to a more comprehensive approach to management of these patients. Trial registration Not applicable
... A cross-sectional survey-based study in the United States revealed the need for population-specific educa-tional initiatives to improve awareness about the symptoms of GERD in populations with different cultural backgrounds [32]. Moreover, other studies were undertaken in industrialized nations, including Sweden, Canada, Switzerland, Norway, and the United Kingdom, to describe epidemiology, prevalence, risk factors, and the effect of public awareness of GERD and related lifestyle changes, these studies reported increasing rate of recently diagonosed patients with GERD year by year resulting in considerable burdens and costs [21,33,34]. ...
Article
Full-text available
Gastroesophageal reflux disease
Article
Full-text available
Background: Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of stomach contents, leading to troublesome symptoms and potential complications. The Montreal definition emphasizes symptom severity, while the Lyon Consensus focuses on physiological aspects, and the Rome IV Conference highlights functional syndromes resembling GERD. This article aims to provide a comprehensive analysis of GERD, consolidating various definitions and perspectives. Aim: The study seeks to clarify the multifaceted nature of GERD, including its pathophysiology, clinical manifestations, diagnostic approaches, and therapeutic strategies. Methods: This narrative review synthesizes existing literature, examining prevalence, morbidity, and mortality associated with GERD, as well as its pathogenesis and the impact of lifestyle factors such as obesity. Data from various studies were analyzed to assess the global prevalence of GERD and its complications. Results: GERD prevalence varies globally, from 2.5% in China to 51.2% in Greece, with significant associations between obesity and GERD-related complications, including esophageal adenocarcinoma (EAC). The economic burden of GERD is substantial, with significant healthcare costs reported in multiple countries. The review also highlights the dual role of Helicobacter pylori, which may both exacerbate and protect against GERD symptoms.
Article
Aim Prehabilitation for colorectal cancer has focused on exercise‐based interventions that are typically designed by clinicians; however, no research has yet been patient‐oriented. The aim of this feasibility study was to test a web‐based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity, diet, smoking cessation, psychological support) co‐designed with five patient partners. Method A longitudinal, two‐armed (website without or with coaching support) feasibility study of 33 patients scheduled for colorectal surgery 2 weeks or more from consent (January–September 2021) in the province of British Columbia, Canada. Descriptive statistics analysed a health‐related quality of life questionnaire (EQ5D‐5L) at baseline ( n = 25) and 3 months postsurgery ( n = 21), and a follow‐up patient satisfaction survey to determine the acceptability, practicality, demand for and potential efficacy in improving overall health. Results Patients had a mean age of 52 years (SD 14 years), 52% were female and they had a mean body mass index of 25 kg m ⁻² (SD 3.8 kg m ⁻² ). Only six patients received a Subjective Global Assessment for being at risk for malnutrition, with three classified as ‘severely/moderately’ malnourished. The majority (86%) of patients intended to use the prehabilitation website, and nearly three‐quarters (71%) visited the website while waiting for surgery. The majority (76%) reported that information, tools and resources provided appropriate support, and 76% indicated they would recommend the PREP prehab programme. About three‐quarters (76%) reported setting goals for lifestyle modification: 86% set healthy eating goals, 81% aimed to stay active and 57% sought to reduce stress once a week or more. No patients contacted the team to obtain health coaching, despite broad interest (71%) in receiving active support and 14% reporting they received ‘active support’. Conclusion This web‐based multimodal prehabilitation programme was acceptable, practical and well‐received by all colorectal surgery patients who viewed the patient‐oriented multimodal website. The feasibility of providing active health coaching support requires further investigation.
Article
Background The cytochrome P450 (CYP) 2C19 genotype has a profound effect on the efficacy of lansoprazole, with less of an influence on vonoprazan. Both are first-choice drugs for the treatment of reflux esophagitis in China.Objective We aimed to estimate the cost-effectiveness of acid-suppressive treatments in Chinese patients with reflux esophagitis over 1 year from the societal perspective.Methods We developed a decision-based Markov model with a 4-week cycle to simulate the economic benefits and quality-adjusted life-years between different treatment strategies for patients with reflux esophagitis: universal lansoprazole, universal vonoprazan, and CYP2C19 genotype-guided strategies. The primary outcome was the incremental cost-effectiveness ratio. Data sources were the published literature, clinical trials, documents, and local charges. We used sensitivity analyses to detect the robustness of the findings and explored subgroup analyses and scenario analyses to make further evaluations.ResultsCompared to lansoprazole, vonoprazan and the CYP2C19 genotype-guided strategy were not preferable for Chinese patients with reflux esophagitis, with an incremental cost-effectiveness ratio of 222,387.1316 yuan/quality-adjusted life-year and 349,627.5000 yuan/quality-adjusted life-year, respectively. Sensitivity analyses showed the impact factors were the utility scores and the expenditures for the maintenance stage with lansoprazole and vonoprazan. When the willingness-to-pay threshold was 215,484 yuan/quality-adjusted life-year, 46.20% of the reflux esophagitis population was willing to pay for vonoprazan, compared with 8.30% for the CYP2C19 genotype-guided strategies. Vonoprazan and the CYP2C19 genotype-guided strategy were cost effective in the severe reflux esophagitis population, and in the reduction of the price of vonoprazan.Conclusions The health economic evaluations revealed that for Chinese patients with reflux esophagitis, vonoprazan and the CYP2C19 genotype-guided strategy were not cost-effective regimens compared with lansoprazole. However, we found that in certain conditions like a reduction in the price of vonoprazan and in patients with severe reflux esophagitis these could be cost-effective.
Article
The management of gastro-oesophageal reflux disease (GERD) continues to garner vast amounts of attention among physicians who care for adults. However, there is an increasing awareness of the fact that this disease, as well as several other lifelong digestive diseases (i.e. Crohn's disease) may actually have their origins in childhood. Paediatric gastro-oesophageal reflux (GER) is likely to share a similar pathophysiology to adult GER, and mounting evidence from published preliminary data suggests a genetic susceptibility to GERD. However, further studies will be necessary to confirm this hypothesis. In children, GER has a distinct presentation from that in adults, with the diagnostic work-up based upon the patient's age as well as their presenting signs and symptoms. Like their adult counterparts, the early detection and treatment of GER in children may result in a better long-term outcome, improved quality-of-life, and a reduction in overall healthcare burden. While the treatment of GER in infants tends to be conservative (i.e. positioning during feeding, smaller feedings), its management in older children parallels that of adults and includes lifestyle changes and pharmacological therapy. However, with persistent symptoms, acid suppression is the mainstay of GERD management in both children and adults. Several studies in children have verified that acid suppression with a proton pump inhibitor is superior to histamine-2 receptor antagonists. Among the proton pump inhibitors, both lansoprazole and omeprazole have been the subject of published adult and paediatric studies demonstrating their short and long-term safety, in addition to their efficacy in a variety of oesophageal and supra-oesophageal GERD related conditions. These two proton pump inhibitors are manufactured as capsules containing enteric-coated granules that can be emptied into soft foods or liquids without compromising their pharmacological effects or pharmacokinetic properties. Lansoprazole is also available as a strawberry-flavoured suspension that is acceptable to children and as an oral disintegrating tablet.
Article
The aim of this study was to determine the prevalence of upper gastrointestinal symptoms (UGIS) in a general population and quantify the relationship of those symptoms to health-care utilization and quality of life. In-person interviews were conducted with 2056 United States and Canadian residents selected at random. Subjects reported frequency and severity for 11 symptoms, prescription and over-the-counter medication use, primary care and specialty physician visits in prior three months, and completed the Psychological General Well-Being Scale. For analyses, subjects were classified into four mutually exclusive symptom groups: gastroesophageal reflux disease (GERD) -like, GERD plus motility-like (GERD+), ulcerlike, and motility-like. Of the total sample, 51.4% reported the occurrence of at least one UGIS in the prior three months. Subjects in the GERD+ and ulcer groups used more prescription medications and were more likely to see a physician about the symptoms (P < 0.001).="" subjects="" with="" symptoms="" demonstrated="" poorer="" quality="" of="" life="" compared="" to="" subjects="" with="" no="" symptoms.="" the="" prevalence="" of="" ugis="" in="" the="" general="" population="" is="" high="" and="" symptoms="" are="" associated="" with="" significant="" health-care="" utilization="" and="" poorer="" quality="" of="">
Article
Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease. To determine the persistence of reflux symptoms and complications associated with GERD. Systematic searches of Medline and EMBASE. In longitudinal studies, 65% (95% CI 54-75%) of patients with complicated GERD and 70% (95% CI 57-83%) of patients with 'defined' GERD had persistent disease at follow-up, whereas 34% (95% CI 27-40%) with infrequent or mild reflux symptoms at baseline had persistent symptoms. Clinical trials of maintenance treatment for at least 6 months after healing of oesophagitis reported mean relapse rates of 75% (95% CI 68-82%) in patients taking placebo and 28% (95% CI 21-35%) in those taking proton pump inhibitors. Retrospective studies reported that 34-41% of individuals with GERD recalled experiencing their symptoms for >10 years. The prevalence of GERD is high (10-20%), whereas the incidence is low (4.5-19.6 cases per 1000 person-years), suggesting that GERD is likely to persist for at least 18 years. Individuals with GERD have persistent reflux symptoms that merit management as a chronic disease; infrequent reflux symptoms are less likely to be chronic and may respond to different management strategies.
Article
Gastroesophageal reflux disease (GERD) is associated with allograft dysfunction after lung transplantation (LTX). We attempted to identify outcomes in LTX recipients with clinical evidence of GERD. Retrospective review of 162 LTX recipients at our institution between January 1994 and June 2006 was performed. GERD was confirmed in symptomatic patients by esophagogastroduodenoscopy (EGD) and/or esophagography. Occurrence of biopsy-proven obliterative bronchiolitis (OB) and bronchiolitis obliterans syndrome (BOS) were analyzed. Kaplan-Meier analysis of survival and Cox proportional hazard analysis of risk factors were performed. GERD was diagnosed in 21 (13%) of patients, usually following LTX (71%). There was no difference in mean survival (1603 +/- 300 vs. 1422 +/- 131 days; log rank P > 0.05), or development of OB (5% vs. 6%, respectively; P > 0.05) in patients with GERD compared with patients without GERD. However, there was correlation between GERD and BOS (P = 0.01). Symptomatic GERD is increased following LTX. Patients with symptomatic GERD demonstrated an increased incidence of BOS, but survival was not affected in this study. More sensitive and specific diagnostic tools should be implemented in all LTX recipients to investigate the impact of symptomatic and silent GERD and thus improve outcomes after LTX.
Article
Increased gastroesophageal reflux (GER) is common in children with cystic fibrosis (CF). We studied the occurrence of acid, weakly acidic (WA), and weakly alkaline (WALK) reflux in children with CF and evaluated a possible surrogate marker for risk of gastric content aspiration. Twenty-four children with CF underwent impedance-pH monitoring for detection of acid (pH < 4), WA (pH 4-7), and WALK-GER (pH > or = 7). In 11 children, cough was objectively recorded with esophageal manometry and the symptom association probability was calculated to determine the reflux-cough relation. Presence of bile acids (BA) was measured in the saliva of 65 patients with CF and 23 healthy children, respectively. Sixteen of the 24 children had increased GER (esophageal acid exposure). The majority of reflux events were acidic in nature. WA reflux was less common and WALK reflux was rare. The sequence reflux-cough was found in 8 of the 11 children and 1 of 11 children had a positive symptom association probability for reflux-cough. The sequence cough-reflux was found in only 3 of the 11 children. Only a small fraction of the total esophageal acid and volume exposure was secondary to cough. Twenty-three of the 65 children with CF had BA in saliva compared with none of the healthy controls. Although WA-GER is uncommon, acid GER is prevalent in children with CF. It is a primary phenomenon and is not secondary to cough. One third of the children with CF have BA in saliva, which may indicate an increased risk for aspiration. However, the impact of salivary BA and potential aspiration on CF pulmonary disease needs further investigation.
Article
To describe the incidence of diagnosis of gastroesophageal reflux disease and acid-related conditions (GERD/ARC) throughout childhood and characterize patterns of diagnosis and treatment with proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H(2)RAs). Cohorts of GERD/ARC children (age 0-18 years) were identified from a large US administrative claims database covering 1999-2005 using ICD-9 codes. Incidence, healthcare utilization (HCU), costs, therapy discontinuation and switching rates were compared between various age and patient groups. Between 2000 and 2005 annual incidence of GERD/ARC diagnosis among infants (age ≤1 year) more than tripled (from 3.4 to 12.3%) and increased by 30% to 50% in other age groups. Patients diagnosed by GI specialists (9.2%) were more likely to be treated with PPIs compared to patients diagnosed by primary care physician (PCP). PPI-initiated patients doubled (from 31.5% in 1999 to 62.6% in 2005) and, when compared with H(2)RA-initiated patients, were associated with 30% less discontinuation and 90% less therapy switching in the first month, and with higher comorbidity burden and pre-treatment total HCU and costs when diagnosed by GI specialists. Limitations: The use of an exploratory definition for GERD/ARC, administrative claims data and potential coding errors in diagnosis codes used in selection process may limit the generalizability of the results. GERD/ARC incidence increased for children of all ages between 2000 and 2005. PCPs made the majority of diagnoses. PPI initiations have now surpassed H(2)RA initiations.
Article
Gastroesophageal reflux disease and acid-related conditions (GERD/ARC) are common in pediatric practice but their costs have not been well characterized. To compare healthcare costs (HCC) and healthcare utilization (HCU) of pediatric GERD/ARC between groups of GERD/ARC patients initiated on histamine-2 receptor antagonists (H(2)RAs) or proton pump inhibitors (PPIs) and matched controls. Children (age < 18 years) diagnosed with GERD or ARC (exploratory category) were identified from a large US claims database (1999-2005) using ICD-9 codes. Costs of pediatric GERD/ARC were estimated by comparing 6-month post-diagnosis HCC between cases and matched controls. GERD/ARC-related HCC and HCU for the year 2005 were further compared between GERD/ARC patients initiated with PPIs vs. H(2)RAs in terms of the cost differences relative to pre-initiation (difference-in-difference) and using multivariate regression to adjust for demographics, pre-treatment health status and pre-treatment costs. A total of 27 865 matched pairs were identified. GERD/ARC patients incurred on average more 6-month total HCC than controls (2386).In2005,1010pediatricpatientswereinitiatedonH(2)RAsorPPIs.About612386). In 2005, 1010 pediatric patients were initiated on H(2)RAs or PPIs. About 61% were initiated on PPIs and incurred 1.8 times higher 6-month post-initiation GERD/ARC-related HCC than H(2)RA-initiated patients (661 vs. 372,p<0.001).Althoughtotal6monthGERD/ARCrelatedHCCincreasedforbothPPIandH(2)RAtreatedpatients,theincreasewas30372, p < 0.001). Although total 6-month GERD/ARC-related HCC increased for both PPI- and H(2)RA-treated patients, the increase was 30% less for PPI-treated patients (173 vs. 246,p=0.521)inthedifferenceindifferenceanalysisand69246, p = 0.521) in the difference-in-difference analysis and 69% less in the multivariate analysis (109 vs. $347, p = 0.040). The use of an exploratory definition for GERD/ARC, administrative claims data and potential coding errors in diagnosis codes used in selection process may limit the generalizability of the results. Pediatric GERD/ARC patients incurred significantly higher healthcare costs compared to similar children without GERD/ARC. Compared to patients initiated with H(2)RAs, patients initiated with PPIs had more baseline comorbidities, and lower GERD/ARC-related HCC after beginning treatment.
Article
We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and associated risk factors, and assess quality of life (QoL) in relation to the frequency and severity of reflux symptoms. A random sample of 1000 residents of Western Sydney were mailed a validated self-report questionnaire. GERD symptoms, risk factors, psychologic distress, QoL, and demographics were measured. The response rate was 73% (n=672; mean age, 46 y; 52% female). A total of 78 [12%, 95% confidence interval (CI): 9-14] had GERD (at least weekly heartburn and/or acid regurgitation). Independent risk factors for GERD were high cholesterol [odds ratio (OR) =3.28, 95% CI: 1.42-7.57, P=0.005] and current smoker (OR=2.47, 95% CI: 1.07-5.70, P=0.03). Anxiety, depression, and neuroticism were not risk factors. Worse physical functioning was the only QoL domain associated with GERD (OR=0.98, 95% CI: 0.97-0.99, P=0.006). QoL was significantly impaired regardless of the severity of GERD for the QoL domains physical function, body pain, vitality, and social function. The frequency of heartburn and acid regurgitation were not associated with significantly reduced QoL domain scores. Cardiac risk factors (high cholesterol and smoking) were independently associated with GERD. Increasing GERD symptom severity is associated with worse QoL scores, whereas GERD symptom frequency did not impact the QoL scores.
Article
Because of inconsistency in terminology and history of diagnosis of gastro-oesophageal reflux disease, accurate epidemiologic information is difficult to compile. Historically, heartburn has been recognised as the classic symptom of gastro-oesophageal reflux disease. Five per cent of the Western adult population experiences heartburn with some frequency. Heartburn may be the sole basis for diagnosis, but many patients have less specific symptoms that do not allow a reliable diagnosis solely from clinical features. No more than two-thirds of patients with gastro-oesophageal reflux disease have oesophagitis on endoscopy. The peak age distribution for patients with gastro-oesophageal reflux disease ranges between 60 and 70 years. Clinical reports concerning long-term natural history and management are scarce. In some patients there is spontaneous improvement without drug therapy. Five to 10% of patients referred to the hospital with gastro-oesophageal reflux disease require antireflux surgery, but most patients are treated by primary-care physicians.