Indian Journal of Gastroenterology

, Volume 30, Issue 3, pp 135–143 | Cite as

Population based study to assess prevalence and risk factors of gastroesophageal reflux disease in a high altitude area

  • Sushil Kumar
  • Saurabh Sharma
  • Tsering Norboo
  • Diskit Dolma
  • Angchuk Norboo
  • Tsering Stobdan
  • S. Rohatgi
  • K. Munot
  • Vineet Ahuja
  • Anoop Saraya
Original Article

Abstract

Aim

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).

Conclusion

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.

Keywords

High altitude Prevalence Risk factors 

References

  1. 1.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20. quiz1943.PubMedCrossRefGoogle Scholar
  2. 2.
    Fujiwara Y, Machida A, Watanabe Y, et al. Association between dinner-to-bed time and gastro-esophageal reflux disease. Am J Gastroenterol. 2005;100:2633–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Du J, Liu J, Zhang H, Yu CH, Li YM. Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination. World J Gastroenterol. 2007;13:6009–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Rezailashkajani M, Roshandel D, Shafaee S, Zali MR. High prevalence of reflux oesophagitis among upper endoscopies of Iranian patients. Eur J Gastroenterol Hepatol. 2007;19:499–506.PubMedCrossRefGoogle Scholar
  5. 5.
    Chang CS, Poon SK, Lien HC, Chen GH. The incidence of reflux esophagitis among the Chinese. Am J Gastroenterol. 1997;92:668–71.PubMedGoogle Scholar
  6. 6.
    Ehsani MJ, Maleki I, Mohammadzadeh F, Mashayekh A. Epidemiology of gastroesophageal reflux disease in Tehran, Iran. J Gastroenterol Hepatol. 2007;22:1419–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Chen M, Xiong L, Chen H, Xu A, He L, Hu P. Prevalence, risk factors and impact of gastroesophageal reflux disease symptoms: a population-based study in South China. Scand J Gastroenterol. 2005;40:759–67.PubMedCrossRefGoogle Scholar
  8. 8.
    Wang JH, Luo JY, Dong L, Gong J, Tong M. Epidemiology of gastroesophageal reflux disease: a general population-based study in Xi’an of Northwest China. World J Gastroenterol. 2004;10:1647–51.PubMedGoogle Scholar
  9. 9.
    Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.PubMedCrossRefGoogle Scholar
  10. 10.
    Fujiwara Y, Higuchi K, Shiba M, et al. Differences in clinical characteristics between patients with endoscopy-negative reflux disease and erosive esophagitis in Japan. Am J Gastroenterol. 2005;100:754–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Saberi-Firoozi M, Khademolhosseini F, Yousefi M, Mehrabani D, Zare N, Heydari ST. Risk factors of gastroesophageal reflux disease in Shiraz, southern Iran. World J Gastroenterol. 2007;13:5486–91.PubMedGoogle Scholar
  12. 12.
    Tseng PH, Lee YC, Chiu HM, et al. Prevalence and clinical characteristics of Barrett’s esophagus in a Chinese general population. J Clin Gastroenterol. 2008;42:1074–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Kang JY. Systematic review: geographical and ethnic differences in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004;20:705–17.PubMedCrossRefGoogle Scholar
  15. 15.
    Suresh Kumar P, Karthik Selvaraj M, Jayanthi V. Prevalence of symptoms of gastro-esophageal reflux amongst medical students. Indian J Gastroenterol. 2006;25:168–9.PubMedGoogle Scholar
  16. 16.
    Rai RR, Sharma M. Prevalence and clinical spectrum of GERD —healthy population. Indian J Gastroenterol. 2004;23 Suppl 2:A12.Google Scholar
  17. 17.
    Madan K, Ahuja V, Gupta SD, Bal C, Kapoor A, Sharma MP. Impact of 24-h esophageal pH monitoring on the diagnosis of gastroesophageal reflux disease: defining the gold standard. J Gastroenterol Hepatol. 2005;20:30–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Vigneri S, Termini R, Leandro G, et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med. 1995;333:1106–10.PubMedCrossRefGoogle Scholar
  19. 19.
    El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007;5:17–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Fujiwara Y, Higuchi K, Watanabe Y, et al. Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan. J Gastroenterol Hepatol. 2005;20:26–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Rajendra S, Alahuddin S. Racial differences in the prevalence of heartburn. Aliment Pharmacol Ther. 2004;19:375–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Guozong P, Guoming X, Meiyun K, et al. Epidemiological study of symptomatic gastroesophageal reflux disease in China: Beijing and Shanghai. Chin J Dig Dis. 2000;1:2–8.CrossRefGoogle Scholar
  23. 23.
    Ho KY, Kang JY, Seow A. Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms. Am J Gastroenterol. 1998;93:1816–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Khoshbaten M. Gastro-esophageal reflux disease in northwestern Tabriz, Iran. Indian J Gastroenterol. 2003;22:138–9.PubMedGoogle Scholar
  25. 25.
    Isolauri J, Laippala P. Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population. Ann Med. 1995;27:67–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Louis E, DeLooze D, Deprez P, et al. Heartburn in Belgium: prevalence, impact on daily life, and utilization of medical resources. Eur J Gastroenterol Hepatol. 2002;14:279–84.PubMedCrossRefGoogle Scholar
  27. 27.
    Valle C, Broglia F, Pistorio A, Tinelli C, Perego M. Prevalence and impact of symptoms suggestive of gastroesophageal reflux disease. Dig Dis Sci. 1999;44:1848–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Bolin TD, Korman MG, Hansky J, Stanton R. Heartburn: community perceptions. J Gastroenterol Hepatol. 2000;15:35–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Kennedy T, Jones R. The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther. 2000;14:1589–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Cameron AJ, Lagergren J, Henriksson C, Nyren O, Locke GR 3rd, Pedersen NL. Gastroesophageal reflux disease in monozygotic and dizygotic twins. Gastroenterology. 2002;122:55–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Labenz J, Jaspersen D, Kulig M, et al. Risk factors for erosive esophagitis: a multivariate analysis based on the ProGERD study initiative. Am J Gastroenterol. 2004;99:1652–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Haque M, Wyeth JW, Stace NH, Talley NJ, Green R. Prevalence, severity and associated features of gastro-oesophageal reflux and dyspepsia: a population-based study. N Z Med J. 2000;113:178–81.PubMedGoogle Scholar
  34. 34.
    Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR 3rd, Rodriguez-Artalejo F. Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther. 2004;19:95–105.PubMedCrossRefGoogle Scholar
  35. 35.
    Ho KY, Kang JY, Seow A. Prevalence of gastrointestinal symptoms in a multiracial Asian population with particular sequence to reflux-type symptoms. Am J Gastroenterol. 1998;93:1816–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Voutilainen M, Sipponen P, Mecklin JP, Juhola M, Farkkila M. Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion. 2000;61:6–13.PubMedCrossRefGoogle Scholar
  37. 37.
    Crane SJ, Talley NJ. Chronic gastrointestinal symptoms in the elderly. Clin Geriatr Med. 2007;23:721–34.PubMedCrossRefGoogle Scholar
  38. 38.
    Pilotto A, Franceschi M, Leandro G, et al. Clinical features of reflux esophagitis in older people: a study of 840 consecutive patients. J Am Geriatr Soc. 2006;54:1537–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Triadafilopoulos G, Sharma R. Features of symptomatic gastroesophageal reflux disease in elderly patients. Am J Gastroenterol. 1997;92:2007–11.PubMedGoogle Scholar
  40. 40.
    Morganstern B, Anandasabapathy S. GERD and Barrett’s esophagus: diagnostic and management strategies in the geriatric population. Geriatrics. 2009;64:9–12.PubMedGoogle Scholar
  41. 41.
    Talley NJ, Howell S, Poulton R. Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study. Am J Gastroenterol. 2004;99:1807–14.PubMedCrossRefGoogle Scholar
  42. 42.
    El-Serag HB, Johanson JF. Risk factors for the severity of erosive esophagitis in Helicobacter pylori-negative patients with gastroesophageal reflux disease. Scand J Gastroenterol. 2002;37:899–904.PubMedCrossRefGoogle Scholar
  43. 43.
    Oliveria SA, Christos PJ, Talley NJ, Dannenberg AJ. Heartburn risk factors, knowledge, and prevention strategies: a population-based survey of individuals with heartburn. Arch Intern Med. 1999;159:1592–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S, Graffner H, Dent J. Natural history of gastro-oesophageal reflux disease diagnosed in general practice. Aliment Pharmacol Ther. 2004;20:751–60.PubMedCrossRefGoogle Scholar
  45. 45.
    Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.PubMedGoogle Scholar
  46. 46.
    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA. 2003;290:66–72.PubMedCrossRefGoogle Scholar
  47. 47.
    Solhpour A, Pourhoseingholi MA, Soltani F, et al. Gastro-esophageal reflux symptoms and body mass index: no relation among the Iranian population. Indian J Gastroenterol. 2008;27:153–5.PubMedGoogle Scholar
  48. 48.
    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut. 2004;53:1730–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Nocon M, Labenz J, Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux—a population-based study. Aliment Pharmacol Ther. 2006;23:169–74.PubMedCrossRefGoogle Scholar
  50. 50.
    Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Ortiz V, Ponce M, Fernandez A, et al. Value of heartburn for diagnosing gastroesophageal reflux disease in severely obese patients. Obesity (Silver Spring). 2006;14:696–700.CrossRefGoogle Scholar
  52. 52.
    Moller ME, Dahl R, Bockman OC. A possible role of the dietary fibre product, wheat bran, as a nitrite scavenger. Food Chem Toxicol. 1988;26:841–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Terry P, Lagergren J, Ye W, Wolk A, Nyren O. Inverse association between intake of cereal fiber and risk of gastric cardia cancer. Gastroenterology. 2001;120:387–91.PubMedCrossRefGoogle Scholar
  54. 54.
    Lundberg JO, Weitzberg E, Lundberg JM, Alving K. Intragastric nitric oxide production in humans: measurements in expelled air. Gut. 1994;35:1543–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Xue S, Valdez D, Collman PI, Diamant NE. Effects of nitric oxide synthase blockade on esophageal peristalsis and the lower esophageal sphincter in the cat. Can J Physiol Pharmacol. 1996;74:1249–57.PubMedGoogle Scholar
  56. 56.
    Konturek JW, Thor P, Lukaszyk A, Gabryelewicz A, Konturek SJ, Domschke W. Endogenous nitric oxide in the control of esophageal motility in humans. J Physiol Pharmacol. 1997;48:201–9.PubMedGoogle Scholar
  57. 57.
    Hirsch DP, Holloway RH, Tytgat GN, Boeckxstaens GE. Involvement of nitric oxide in human transient lower esophageal sphincter relaxations and esophageal primary peristalsis. Gastroenterology. 1998;115:1374–80.PubMedCrossRefGoogle Scholar
  58. 58.
    Klauser AG, Schindlbeck NE, Muller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335:205–8.PubMedCrossRefGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2010

Authors and Affiliations

  • Sushil Kumar
    • 1
  • Saurabh Sharma
    • 1
  • Tsering Norboo
    • 2
  • Diskit Dolma
    • 2
  • Angchuk Norboo
    • 2
  • Tsering Stobdan
    • 2
  • S. Rohatgi
    • 1
  • K. Munot
    • 1
  • Vineet Ahuja
    • 1
  • Anoop Saraya
    • 1
  1. 1.Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.District HospitalLehIndia

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