Gastroenterology

Gastroenterology

Volume 158, Issue 5, April 2020, Pages 1250-1261.e2
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Prevalence of Gastroesophageal Reflux Disease and Proton Pump Inhibitor-Refractory Symptoms

https://doi.org/10.1053/j.gastro.2019.12.014Get rights and content

Background & aims

There are few data on the prevalence of gastroesophageal reflux disease (GERD) in the United States. We performed a population-based study to determine the prevalence of GERD symptoms and persistent GERD symptoms despite use of proton pump inhibitors (PPIs).

Methods

We conducted the National Gastrointestinal Survey in 2015 using MyGiHealth, an app that guides participants through National Institutes of Health gastrointestinal Patient-Reported Outcomes Measurement Information System surveys. Primary outcomes were prevalence of GERD symptoms in the past and persistence of GERD symptoms (heartburn or regurgitation 2 or more days in past week) among participants taking PPIs. Population weights were applied to the data and multivariable regression was used to adjust for confounding.

Results

Among 71,812 participants, 32,878 (44.1%) reported having had GERD symptoms in the past and 23,039 (30.9%) reported having GERD symptoms in the past week. We also found that 35.1% of those who had experienced GERD symptoms were currently on therapy (55.2% on PPIs, 24.3% on histamine-2 receptor blockers, and 24.4% on antacids). Among 3229 participants taking daily PPIs, 54.1% had persistent GERD symptoms. Younger individuals, women, Latino individuals, and participants with irritable bowel syndrome or Crohn’s disease were more likely to have continued symptoms, even when taking PPIs.

Conclusions

Using a population-based survey, we found GERD symptoms to be common: 2 of 5 participants have had GERD symptoms in the past and 1 of 3 had symptoms in the past week. We also found that half of PPI users have persistent symptoms. Given the significant effect of GERD on quality of life, further research and development of new therapies are needed for patients with PPI-refractory GERD symptoms.

Section snippets

Study Design, Data Source, and Study Population

In October 2015, our group conducted the “National Gastrointestinal (GI) Survey,” a population-based audit of GI symptoms in more than 71,000 community-dwelling Americans.12, 13, 14, 15 The survey was administered via MyGiHealth, a mobile app that uses AEGIS (Automated Evaluation of GI Symptoms), an automated algorithm that has previously been described in detail.16 AEGIS asked users to “Select any symptom(s) you experienced in the past week” and “Please check any of these GI symptom(s) that

Study Cohort

In all, 1.3 million individuals were invited to complete the National GI Survey with the opportunity to participate in the study up until at least 70,000 surveys were completed. Ultimately, 124,674 (9.4%) individuals accessed the survey, of whom 71,812 (57.6%) completed the questionnaires and were included in the study. Table 1 lists the demographic information of the study cohort.

GERD Symptoms Within the Past 7 Days Among Overall Cohort

Among 71,812 participants, we found that 32,878 (PW 44.1%) had ever experienced GERD symptoms in the past and

Discussion

In this population-based survey, we found that GERD symptoms are very common in the community. More than 2 of 5 Americans have experienced heartburn or regurgitation in the past, whereas nearly 1 of 3 experienced these symptoms in the past week. In addition, among those managing their symptoms with a daily PPI, we found that more than half still have persistent, troublesome GERD symptoms.

Our prevalence of presumptive GERD is largely in line with prior estimates from other US cross-sectional and

Acknowledgments

Author contributions: Sean D. Delshad: study design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. Christopher V. Almario: study concept and design; acquisition of data; analysis and interpretation of data; statistical analysis; drafting of the manuscript; critical revision of the manuscript for important intellectual content; administrative, technical, or material support; study supervision. William D.

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    Conflicts of interest Brennan M.R. Spiegel and William D. Chey are consultants for Ironwood Pharmaceuticals and patent holders and principals at My Total Health. Christopher V. Almario has a stock option grant in My Total Health. Sean D. Delshad discloses no conflicts.

    FundingThis study was funded by Ironwood Pharmaceuticals. The study sponsor did not have a role in the collection, analysis, or interpretation of data, or drafting of the manuscript. The Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) is supported by The Marc and Sheri Rapaport Fund for Digital Health Sciences & Precision Health. Christopher V. Almario was supported by a career development award from the American College of Gastroenterology. Christopher V. Almario and Brennan M.R. Spiegel are supported by National Institutes of Health/National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant UL1TR001881.

    Author names in bold designate shared co-first authorship.

    Authors share co-first authorship.

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