Epidemiology

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There is not a gold standard for the definition of GORD [1]. As 24 hour pH-metry studies have shown that only a minority of acid episodes are associated with GORD symptoms and correlate only somewhat with the presence of oesophagitis, definition of GORD has been a point of discussion during the last decade. The Geneval workshop defined GORD pragmatically as "heartburn symptoms sufficient to impair quality of life" knowing that there is an overlap with the definition of dyspepsia and that this definition will cause confusion between the definition of a disease entitiy and a working diagnostic criteria for clinical use.

Heartburn prevalence ranges from 9% in Europe to 38% in Northern Europe and 42% in the US [2]. Frequency of oesophagitis has been described with a prevalence from 4-76.9% [1]. One of the predisposing factors for GORD is the hiatal hernia (Fig. 1), which can be found in 2.9-20% of patients if it is smaller than 2 cm and from 4.1-40% if the hiatal hernia is more than 2 cm [1].

In patients with reflux symptoms or oesophagitis a lower prevalence of Helicobacter pylori infection was found in some studies, suggesting a possible protective effect of Helicobacter pylori infection [3]-[6]. A systematic review evaluating 20 studies found the average prevalence of Helicobacter pylori infection in patients with GORD to be 38% from a world perspective [1], [7]. The pooled estimate of the odds ratio for the prevalence of Helicobacter pylori in patients with GORD was 0.60 (0.47-0.78 CI, Table 1). However evidence for this protective role was equivocal. Whereas a lower prevalence of Helicobacter pylori infection was found among asian GORD patients [8], [9], this effect is less prominent in caucasian populations.

These ethnic differences may be attributed to different patterns of Helicobacter pylori gastritis among these populations and therefore may also explain different study results.

Bile Acid Reflux Esophagitis
Fig. 1. The impact of hiatal hernia in the pathophysiology of GORD (LOS: lower oesophageal sphincter)

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