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Impact of Gastroesophageal Reflux Disease on Daily Life: The Systematic Investigation of Gastrointestinal Diseases in China (SILC) Epidemiological Study

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Impact of Gastroesophageal Reflux Disease on Daily Life: The Systematic Investigation of Gastrointestinal Diseases in China (SILC) Epidemiological Study

Rui Wang et al. Health Qual Life Outcomes.

Abstract

Background: Gastroesophageal reflux disease imposes a significant burden of illness in Western populations. However, data on the impact of reflux symptoms on daily life in Asian populations are scarce. The current study aimed to evaluate the impact of GERD (defined on the basis of symptoms) on health-related quality-of-life (HRQoL) in individuals from five regions in China, as part of the Systematic Investigation of Gastrointestinal Diseases in China (SILC) study.

Methods: In total, 18 000 residents were randomly selected from across five regions of China and asked to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire (RDQ). A randomly selected subsample of one-fifth of subjects (20% from each region) completed Chinese versions of the 36-item self-administered (SF-36) questionnaire and Epworth Sleepiness Scale (ESS) questionnaire. Reflux symptoms were defined as the presence of heartburn and/or regurgitation. Symptom-defined GERD was diagnosed as mild heartburn and/or regurgitation ≥2 days per week, or moderate/severe heartburn and/or regurgitation ≥1 day a week, based on the Montreal Definition of GERD for population-based studies.

Results: The response rate was 89.4% for the total sample (16 091/18 000), and for the 20% subsample (3219/3600). Meaningful impairment was observed in all 8 SF-36 dimensions in participants with symptom-defined GERD, in 7 of the 8 SF-36 dimensions in participants with troublesome reflux symptoms, and in 6 of the 8 SF-36 dimensions in participants with reflux symptoms below the threshold for symptom-defined GERD. Meaningful daytime sleepiness was also observed in each of these groups. The proportion of individuals reporting troublesome symptoms increased as reflux symptom frequency and severity approached the threshold for symptom-defined GERD, and this was associated with concomitant decreases in all HRQoL measures. Troublesome symptoms were reported by 68.2% (75/110) of individuals with symptom-defined GERD.

Conclusions: GERD diagnosed using symptom/frequency criteria (recommended for population-based studies), or based on troublesome reflux symptoms (recommended for the clinic), is associated with significantly impaired HRQoL in Chinese individuals. However, patient groups identified using these definitions do not overlap completely, suggesting that they capture slightly different, though clinically relevant, GERD populations.

Figures

Figure 1
Figure 1
Dimension scores of the 36-item Short-Form Health Survey (SF-36) in A) participants with and without symptom-defined gastroesophageal reflux disease (GERD), B) participants with and without reflux symptoms below the threshold for symptom-defined GERD and C) patients with and without troublesome reflux symptoms. PF, physical functioning; RP, role limitation-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role limitation-emotional; MH, mental health. *Meaningful impairment (statistically significant [p < 0.05] decrease of ≥5 points).
Figure 2
Figure 2
The distribution of Epworth Sleepiness Scale (ESS) scores (clinically meaningful [>12], borderline clinically meaningful B1010B1111B1212 and non-clinically meaningful [<10]) among patients with and without symptom-defined gastroesophageal reflux disease (GERD).
Figure 3
Figure 3
The relationship between reflux symptom frequency/severity and 36-item Short-Form Health Survey (SF-36) dimension scores. PF: physical functioning; RP: role limitation-physical; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role limitation-emotional; MH: mental health. † = not meaningfully impaired compared to participants with no reflux symptoms.

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