Gastroesophageal reflux among different racial groups in the United States

Gastroenterology. 2004 Jun;126(7):1692-9. doi: 10.1053/j.gastro.2004.03.077.


Background & aims: White people in the United States are several-fold more affected by esophageal adenocarcinoma than black people. It remains unknown whether this racial discrepancy reflects a higher prevalence of gastroesophageal reflux disease (GERD) symptoms or a higher degree of esophageal damage.

Methods: A cross-sectional survey followed by endoscopy was performed among employees at a VA medical center. The association between race and GERD symptoms and erosive esophagitis was analyzed in logistic regression analyses controlling for demographic, clinical, and histologic variables.

Results: A total of 496 of 915 people (54%) returned interpretable questionnaires, and endoscopy was performed in 215 participants. The mean age was 45 years, and 336 (68%) were women. Racial distribution was 43% black, 34% white, and 23% other races. Heartburn occurring at least weekly was reported in 27%, 23%, and 24% of these racial groups, respectively. The age-adjusted prevalence of heartburn or regurgitation was not significantly different among the groups. Erosive esophagitis was found in 50 of 215 participants (23%); 31 of these cases were mild. Only one person had Barrett's esophagus (0.4%). For weekly heartburn or regurgitation, black participants had significantly less frequent erosive esophagitis than white participants (24% vs. 50%; P = 0.03). With multiple adjustments, black participants had a persistently lower risk of esophagitis (adjusted odds ratio, 0.22-0.46; P < 0.001).

Conclusions: White and black people in the United States have a similarly high prevalence of GERD symptoms. However, black people have a lower prevalence of esophagitis for the same frequency of GERD symptoms. Barrett's esophagus was rare in this study, even among those with frequent symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Black or African American / statistics & numerical data*
  • Endoscopy, Gastrointestinal
  • Esophagitis / ethnology
  • Esophagitis / pathology
  • Female
  • Gastritis / ethnology
  • Gastritis / pathology
  • Gastroesophageal Reflux / ethnology*
  • Gastroesophageal Reflux / pathology
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Risk Factors
  • United States / epidemiology
  • White People / statistics & numerical data*