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Prevalence and risk factors for gastroesophageal reflux disease in the Indian population: A meta-analysis and meta-regression study

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Abstract

Background

Indian population–based studies on the prevalence and risk factors for gastroesophageal reflux disease (GERD) are scanty, and a meta-analysis and a meta-regression of prevalence and risk factors based on the existing data have not yet been reported.

Methods

A systematic review of all the available publications from India reporting data regarding prevalence and risk factors of GERD was performed. Heterogeneity was assessed using I2 statistics. The meta-analysis was undertaken to measure the average proportion reported in the existing studies, and meta-regression models were used to explore the risk factors for it.

Results

The nine studies included 20,614 subjects; the prevalence of GERD ranged from 5% to 28.5%. The summary effect size (weighted average proportion) estimated by meta-analytic model was 0.1415 (95% confidence interval [CI] 0.099 to 0.197). The results for the test of heterogeneity that included tau2 (0.37, 95% CI 0.21 to 1.80), I2 (98.9%, 95% CI 98.01 to 99.77), and the Q-statistic (707.670; p < 0.0001) suggested high heterogeneity in the effect sizes. The pooled proportion of GERD (random-effects model) was 15.573 (95% CI 11.046 to 20.714). In the meta-regression model, sample size (p = 0.005) explained about 50% of the heterogeneity.

Conclusion

The pooled prevalence of GERD in the Indian population is 15.6 (95% CI 11.046 to 20.714). The risk factors were age, body mass index (BMI), non-vegetarian diet, tea/coffee intake, tobacco, and alcohol consumption. However, there was significant heterogeneity in the studies.

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References

  1. De Giorgi F, Palmiero M, Esposito I, Mosca F, Cuomo R. Pathophysiology of gastro-oesophageal reflux disease. Acta Otorhinolaryngol Ital. 2006;26:241–6.

    PubMed  PubMed Central  Google Scholar 

  2. Clarrett DM, Hachem C. Gastroesophageal reflux disease (GERD). Mo Med. 2018;115:214–8.

    PubMed  PubMed Central  Google Scholar 

  3. Bhatia SJ, Reddy DN, Ghoshal UC, et al. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011;30:118–27.

  4. Savarino E, Marabotto E, Bodini G, et al. Epidemiology and natural history of gastroesophageal reflux disease. Minerva Gastroenterol Dietol. 2017;63:175–83.

  5. Geeraerts A, Van Houtte B, Clevers E, et al. Gastroesophageal reflux disease-functional dyspepsia overlap: do birds of a feather flock together? Am J Gastroenterol. 2020;115(8):1167–82.

    Article  Google Scholar 

  6. Spechler SJ. GERD and its complications. Mt Sinai J Med. 2000;67:106–11.

    CAS  PubMed  Google Scholar 

  7. Chowdhury SD, George G, Ramakrishna K, et al. Prevalence and factors associated with gastroesophageal reflux disease in southern India: a community-based study. Indian J Gastroenterol. 2019;38:77–82.

  8. Chandran S, Raman R, Kishor M, Nandeesh HP. The effectiveness of mindfulness meditation in relief of symptoms of depression and quality of life in patients with gastroesophageal reflux disease. Indian J Gastroenterol. 2019;38:29–38.

    Article  Google Scholar 

  9. Qumseya BJ, Bukannan A, Gendy S, et al. Systematic review and meta-analysis of prevalence and risk factors for Barrett’s esophagus. Gastrointest Endosc. 2019;90:707–17. e1.

  10. Nejat Pish-Kenari F, Qujeq D, Maghsoudi H. Some of the effective factors in the pathogenesis of gastro-oesophageal reflux disease. J Cell Mol Med. 2018;22:6401–4.

    Article  Google Scholar 

  11. Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? J Neurogastroenterol Motil. 2018;24:559–69.

  12. Wang KY, Chen YW, Wang TN, et al. Predictor of slower gastric emptying in gastroesophageal reflux disease: survey of an Asian-Pacific cohort. J Gastroenterol Hepatol. 2019;34:837–42.

  13. Bhatia SJ, Makharia GK, Abraham P, et al. Indian consensus on gastroesophageal reflux disease in adults: a position statement of the Indian Society of Gastroenterology. Indian J Gastroenterol. 2019;38:411–40.

  14. Goh KL, Choi KD, Choi MG, et al. Factors influencing treatment outcome in patients with gastroesophageal reflux disease: outcome of a prospective pragmatic trial in Asian patients. BMC Gastroenterol. 2014;14:156.

  15. Rogers BD, Gyawali CP. Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease. Indian J Gastroenterol. 2019;38:371–7.

    Article  Google Scholar 

  16. Kumar S, Sharma S, Norboo T, et al. Population based study to assess prevalence and risk factors of gastroesophageal reflux disease in a high altitude area. Indian J Gastroenterol. 2011;30:135–43.

  17. Jung JG, Kang HW, Hahn SJ, et al. Vegetarianism as a protective factor for reflux esophagitis: a retrospective, cross-sectional study between Buddhist priests and general population. Dig Dis Sci. 2013;58:2244–52.

  18. Kubo A, Block G, Quesenberry CP Jr, Buffler P, Corley DA. Effects of dietary fiber, fats, and meat intakes on the risk of Barrett’s esophagus. Nutr Cancer. 2009;61:607–16.

  19. Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J Thorac Dis. 2019;11:S1594–601.

    Article  Google Scholar 

  20. Sharma PK, Ahuja V, Madan K, Gupta S, Raizada A, Sharma MP. Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in northern India. Indian J Gastroenterol. 2011;30:128–34.

  21. Baruah B, Kumar T, Das P, et al. Prevalence of eosinophilic esophagitis in patients with gastroesophageal reflux symptoms: a cross-sectional study from a tertiary care hospital in North India. Indian J Gastroenterol. 2017;36:353–60.

  22. Zhao Y, Li Y, Hu J, et al. The effect of helicobacter pylori eradication in patients with gastroesophageal reflux disease: a meta-analysis of randomized controlled studies. Dig Dis. 2020;38:261–268.

    Article  Google Scholar 

  23. Ghoshal UC, Singh R, Chang FY, et al. Epidemiology of uninvestigated and functional dyspepsia in Asia: facts and fiction. J Neurogastroenterol Motil. 2011;17:235–44.

  24. Chourasia D, Misra A, Tripathi S, Krishnani N, Ghoshal UC. Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry. Indian J Gastroenterol. 2011;30:12–21.

    Article  Google Scholar 

  25. Ghoshal UC, Chourasia D. Gastroesophageal reflux disease and Helicobacter pylori: what may be the relationship? J Neurogastroenterol Motil. 2010;16:243–50.

    Article  Google Scholar 

  26. Chourasia D, Ghoshal UC. Pathogenesis of gastro-oesophageal reflux disease: what role do Helicobacter pylori and host genetic factors play? Trop Gastroenterol. 2008;29:13–9.

    PubMed  Google Scholar 

  27. Sandhu DS, Fass R. Current trends in the management of gastroesophageal reflux disease. Gut Liver. 2018;12:7–16.

    Article  CAS  Google Scholar 

  28. Ghoshal UC, Singh R, Rai S. Prevalence and risk factors for gastroesophageal reflux disease in a rural Indian population. Indian J Gastroenterol. 2021;40 https://doi.org/10.1007/s12664-020-01135-7.

  29. Bhalaghuru CM, Vijaya S, Jayanthi V. Symptomatic gastroesophageal reflux amongst hospital personnel in South India. Indian J Med Sci. 2011;65:355–9.

    Article  CAS  Google Scholar 

  30. Wang HY, Leena KB, Plymoth A, et al. Prevalence of gastro-esophageal reflux disease and its risk factors in a community-based population in southern India. BMC Gastroenterol. 2016;16:36.

  31. Sharma A, Sharma PK, Puri P. Prevalence and the risk factors of gastro-esophageal reflux disease in medical students. Med J Armed Forces India. 2018;74:250–4.

    Article  Google Scholar 

  32. Arivan R, Deepanjali S. Prevalence and risk factors of gastro-esophageal reflux disease among undergraduate medical students from a southern Indian medical school: a cross-sectional study. BMC Res Notes. 2018;11:448.

    Article  Google Scholar 

  33. Ghoshal UC, Singh R, Rai S, et al. Prevalence and risk factors for gastroesophageal reflux disease in a rural Indian population. Submitted to 6th Asian Postgraduate Course on Neurogastroenterology and Motility. 2020.

  34. Jung HK, Halder S, McNally M, et al. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther. 2007;26:453–61.

    Article  Google Scholar 

  35. 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.

    Article  Google Scholar 

  36. 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.

  37. Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259–68.

    Article  CAS  Google Scholar 

  38. El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–9.

    Article  Google Scholar 

  39. Chiocca JC, Olmos JA, Salis GB, et al. Prevalence, clinical spectrum and atypical symptoms of gastro-oesophageal reflux in Argentina: a nationwide population-based study. Aliment Pharmacol Ther. 2005;22:331–42.

    Article  CAS  Google Scholar 

  40. Isolauri J, Laippala P. Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population. Ann Med. 1995;27:67–70.

    Article  CAS  Google Scholar 

  41. 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.

    Article  CAS  Google Scholar 

  42. 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.

  43. Lofdahl HE, Lane A, Lu Y, et al. Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma. Eur J Gastroenterol Hepatol. 2011;23:128–32.

    Article  Google Scholar 

  44. Ronkainen J, Aro P, Storskrubb T, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40:275–85.

  45. Terry P, Lagergren J, Wolk A, Nyrén O. Reflux-inducing dietary factors and risk of adenocarcinoma of the esophagus and gastric cardia. Nutr Cancer. 2000;38:186–91.

    Article  CAS  Google Scholar 

  46. Mohammed I, Cherkas LF, Riley SA, Spector TD, Trudgill NJ. Genetic influences in gastro-oesophageal reflux disease: a twin study. Gut. 2003;52:1085–9.

    Article  CAS  Google Scholar 

  47. Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Can Med Assoc J. 1982;126:46–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Mostaghni A, Mehrabani D, Khademolhosseini F, et al. Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran. World J Gastroenterol. 2009;15:961–5.

  49. Nasseri-Moghaddam S, Mofid A, Ghotbi MH, et al. Epidemiological study of gastro-oesophageal reflux disease: reflux in spouse as a risk factor. Aliment Pharmacol Ther. 2008;28:144–53.

    Article  CAS  Google Scholar 

  50. 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.

  51. Nouraie M, Radmard AR, Zaer-Rezaii H, Razjouyan H, Nasseri-Moghaddam S, Malekzadeh R. Hygiene could affect GERD prevalence independently: a population-based study in Tehran. Am J Gastroenterol. 2007;102:1353–60.

    Article  Google Scholar 

  52. Nouraie M, Razjouyan H, Assady M, Malekzadeh R, Nasseri-Moghaddam S. Epidemiology of gastroesophageal reflux symptoms in Tehran, Iran: a population-based telephone survey. Arch Iran Med. 2007;10:289–94.

    PubMed  Google Scholar 

  53. Cao H, Huang X, Zhi X, Han C, Li L, Li Y. Association between tea consumption and gastroesophageal reflux disease: a meta-analysis. Medicine (Baltimore). 2019;98:e14173.

    Article  Google Scholar 

  54. 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.

    Article  Google Scholar 

  55. 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.

    Article  Google Scholar 

  56. Kitapçioğlu G, Mandiracioğlu A, Caymaz Bor C, Bor S. Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community. Turk J Gastroenterol. 2007;18:14–9.

  57. Sperber AD, Halpern Z, Shvartzman P, et al. Prevalence of GERD symptoms in a representative Israeli adult population. J Clin Gastroenterol. 2007;41:457–61.

  58. Nirwan JS, Hasan SS, Babar ZU, Conway BR, Ghori MU. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis. Sci Rep. 2020;10:5814.

    Article  CAS  Google Scholar 

  59. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80.

  60. Collaborators GBDG-oRD. The global, regional, and national burden of gastro-oesophageal reflux disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5:561–81.

    Article  Google Scholar 

  61. Wong SW, Chan WK. Epidemiology of non-alcoholic fatty liver disease in Asia. Indian J Gastroenterol. 2020;39:1–8.

    Article  Google Scholar 

  62. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

  63. Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol. 2017;32:378–87.

    Article  Google Scholar 

  64. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2020;S0016-5085(20)30487-X.

  65. Chourasia D, Achyut BR, Tripathi S, Mittal B, Mittal RD, Ghoshal UC. Genotypic and functional roles of IL-1B and IL-1RN on the risk of gastroesophageal reflux disease: the presence of IL-1B-511*T/IL-1RN*1 (T1) haplotype may protect against the disease. Am J Gastroenterol. 2009;104:2704–13.

  66. Shah A, Jones MP, Holtmann GJ. Basics of meta-analysis. Indian J Gastroenterol. 2020.

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  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Sushmita Rai, Akshay Kulkarni & Uday C. Ghoshal

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  1. Sushmita Rai
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Correspondence to Uday C. Ghoshal.

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Rai, S., Kulkarni, A. & Ghoshal, U.C. Prevalence and risk factors for gastroesophageal reflux disease in the Indian population: A meta-analysis and meta-regression study. Indian J Gastroenterol 40, 209–219 (2021). https://doi.org/10.1007/s12664-020-01104-0

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