Prevalence of gastro-oesophageal reflux disease in general practice

Background and objective: While there is an ever rising prevalence of gastro-oesophageal reflux disease among people in the western world, the actual number are usually underestimated, because many afflicted persons do not seek medical care. This study was undertaken to determine the frequency of unrecognized reflux disease among an unselected patient cohort in general practice. In addition, answers by these patients to a questionnaire were evaluated. Patients and methods: 162 consecutive patients of a general practice without known gastro-oesophageal reflux took part. After the questionnaire had been filled in a history was obtained with semi-quantitative grading of dyspeptic symptoms, and all underwent a physical examination. A gastroscopy was offered to all patients. Gastro-oesophageal reflux was diagnosed when endoscopy revealed typical oesophageal lesions and/or there were at least moderately severe reflux symptoms that had reduced the patient's quality of life. Results: 82 patients (51%) had reflux disease. 121 patients underwent endoscopy. Structural changes (reflux oesophagitis, Barrett metaplasia) were seen in 28 of the 82 patients with reflux disease (34%), 17% of the entire cohort. Axial hiatus hernia, positive family history, advancing age, over-weight, female gender and treatment with MAIDS or aspirin were significant risk factors in the development of reflux disease. Patients with reflux disease significantly more frequently suffered from hoarseness and/or cough. Positive or negative predictability of the questionnaire regarding the diagnosis of reflux disease was 94% each way. Conclusion: The prevalence of unrecognized gastro-oesophageal reflux disease in the population is extraordinarily high. One quarter to one third of those with reflux disease have cough or hoarseness. The disease can apparently be reliably diagnosed by a standardized questionnaire.