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      The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?

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          Abstract

          Background/Aims

          Gastroesophageal reflux disease (GERD) is a common disease globally with increasing prevalence and consequently greater burden on the Healthcare system. Traditionally, GERD has been considered a disease of middle-aged and older people. Since risk factors for GERD affect a growing number of the adult population, concerns have been raised that increasingly younger people may develop GERD. We aim to determine if the proportion of younger patients has increased among the GERD population.

          Methods

          The incidence of GERD as well as several variables were evaluated during an 11-year period. Explorys was used to evaluate datasets at a “Universal” and Healthcare system in northern Ohio to determine if trends at a local level reflected those at a universal level. GERD patients were classified into 7 age groups (15–19, 20–29, 30–39, 40–49, 50–59, 60–69, and ≥70 years).

          Results

          The proportion of patients with GERD increased in all age groups, except for those who were ≥70 years in the universal dataset ( P < 0.001) and those who were ≥60 years in the Healthcare system ( P < 0.001). The greatest rise was seen in 30–39 years in both datasets ( P < 0.001). Similarly, the proportion of GERD patients who were using proton pump inhibitors increased in all age groups except for those who were ≥70 years in both datasets ( P < 0.001), with the greatest increase being the group 30–39 years ( P < 0.001).

          Conclusion

          Over the last decade, there has been a significant increase in the proportion of younger patients with GERD, especially those within the age range of 30–39 years.

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          Most cited references21

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          Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis.

          Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them.
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            Complications of Proton Pump Inhibitor Therapy.

            Safety issues associated with proton pump inhibitors (PPIs) have recently attracted widespread media and lay attention. Gastroenterologists are frequently asked about the appropriateness of PPI therapy for specific patients. Furthermore, some patients may have had PPI therapy discontinued abruptly or inappropriately due to safety concerns. Faced with such a wide variety of potentially serious adverse consequences, prescribers need to evaluate the evidence objectively to discern the likelihood that any reported association might actually be causal. Here, we review many of the proposed adverse consequences of PPI therapy and apply established criteria for the determination of causation. We also consider the potential contribution of residual confounding in many of the reported studies. Evidence is inadequate to establish causal relationships between PPI therapy and many of the proposed associations. Residual confounding related to study design and the over-extrapolation of quantitatively small estimates of effect size have probably led to much of the current controversy about PPI safety. In turn, this has caused unnecessary concern among patients and prescribers. The benefits of PPI therapy for appropriate indications need to be considered along with the likelihood of the proposed risks. Patients with a proven indication for a PPI should continue to receive it in the lowest effective dose. PPI dose escalation and continued chronic therapy in those unresponsive to initial empiric therapy is discouraged.
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              Systematic review: the burden of disruptive gastro-oesophageal reflux disease on health-related quality of life.

              About one-third of patients with gastro-oesophageal reflux disease (GERD) have frequent and/or severe reflux symptoms ('disruptive GERD'). The relative burden of disruptive GERD on health-related quality of life (HRQL) has not been systematically investigated. To assess the burden of disruptive vs. nondisruptive GERD on HRQL. Systematic searches were conducted in PubMed and Embase. To be included, studies had to have used validated questionnaires to assess HRQL. Nineteen studies were included. Data on the comparative burden of frequent (ranging from daily to ≥weekly) and severe reflux symptoms were provided in eight and 13 studies respectively; six reported on the additional burden of nocturnal symptoms. Compared with individuals with nondisruptive GERD, those with disruptive GERD had 2.4-times and 1.5-times higher mean rates of absenteeism and presenteeism respectively (five studies), 1.5-times lower sleep quality scores (three studies), 1.1-times lower mean summary scores for physical and mental health (five studies) and 1.3-times lower mean scores for psychological and general well-being (four studies). Increasing symptom frequency and severity both increased the burden of disease to a similar extent. The presence of nocturnal symptoms in addition to daytime symptoms led to worsening of physical health, but their effect on mental health and work productivity was less clear. Disruptive GERD is associated with a high burden of disease compared with occasional or mild reflux symptoms. Disease management needs to vary across the GERD spectrum and should be tailored to patients' requirements for optimal therapeutic outcomes. © 2012 Blackwell Publishing Ltd.
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                Author and article information

                Journal
                J Neurogastroenterol Motil
                J Neurogastroenterol Motil
                Journal of Neurogastroenterology and Motility
                Korean Society of Neurogastroenterology and Motility
                2093-0879
                2093-0887
                October 2018
                01 October 2018
                : 24
                : 4
                : 559-569
                Affiliations
                [1 ]The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
                [2 ]Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
                [3 ]Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
                [4 ]Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
                Author notes
                [* ]Correspondence: Ronnie Fass, MD, FACG, Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA, Tel: +1-216-778-3145, Fax: +1-216-957-8410, E-mail: ronnie.fass@ 123456gmail.com
                Article
                jnm-24-559
                10.5056/jnm18140
                6175565
                30347935
                f53cd6cf-557b-41f1-8f09-259200c4d882
                © 2018 The Korean Society of Neurogastroenterology and Motility

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 August 2018
                : 22 August 2018
                : 28 August 2018
                Categories
                Original Article

                Neurology
                age,epidemiology,gastroesophageal reflux disease,proton pump inhibitors
                Neurology
                age, epidemiology, gastroesophageal reflux disease, proton pump inhibitors

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