前沿关注系列（19）：美国GERD流行现状调查
（来源：Sean D. Delshad, et al. Gastroenterology, 2020, 158(5): 1250-1261.）
背景及目的：既往极少有GERD在美国流行情况的资料。我们进行了基于人口的GERD症状流行情况研究、以及PPI使用情况下仍持续存在GERD症状的调查。
BACKGROUND & AIMS: There are few data on the prevalence of gastroesophageal reflux disease (GERD) in the United States. We performed a population-based study to determine the prevalence of GERD symptoms and persistent GERD symptoms despite use of proton pump inhibitors (PPIs).
方法：2015年NIH通过一款MyGiHealth的手机APP，对使用者进行指导自主报告胃肠道情况。主要的调查内容为既往GERD症状的流行情况、以及服用PPI者的GERD症状持续情况（定义为最近一周内发生2次及以上的烧心或反酸）。结果进行人口权重调整及多元回归分析。
METHODS: We conducted the National Gastrointestinal Survey in 2015 using MyGiHealth, an app that guides participants through National Institutes of Health gastrointestinal Patient-Reported Outcomes Measurement Information System surveys. Primary outcomes were prevalence of GERD symptoms in the past and persistence of GERD symptoms (heartburn or regurgitation 2 or more days in past week) among participants taking PPIs. Population weights were applied to the data and multivariable regression was used to adjust for confounding.
结果：在71812名参与者中，32878名（44.1%）报告既往出现过GERD症状，23039名（30.9%）报告最近一周有GERD症状。研究还发现报告有GERD症状者35.1%正在进行治疗（55.2%使用PPI，24.3%使用H2RB，24.4%使用抗酸药）。在3229名每日使用PPI者中，54.1%存在持续的GERD症状。年轻、女性、拉丁裔、IBS或克罗恩病患者即使在服用PPI时也更易持续出现症状。
RESULTS: Among 71,812 participants, 32,878 (44.1%) reported having had GERD symptoms in the past and 23,039 (30.9%) reported having GERD symptoms in the past week. We also found that 35.1% of those who had experienced GERD symptoms were currently on therapy (55.2% on PPIs,24.3% on histamine-2 receptor blockers, and 24.4% on antacids). Among 3229 participants taking daily PPIs, 54.1% had persistent GERD symptoms. Younger individuals, women, Latino individuals, and participants with irritable bowel syndrome or Crohn’s disease were more likely to have continued symptoms, even when taking PPIs.
结论：本研究发现，GERD症状非常普遍（2/5人口曾发生过，1/3最近1周发生过）。此外，PPI使用者中半数仍有持续的症状。鉴于GERD对生活质量的影响，对这些患者需要进行更多研究、发展新的治疗方法。
CONCLUSIONS: Using a population-based survey, we found GERD symptoms to be common: 2 of 5 participants have had GERD symptoms in the past and 1 of 3 had symptoms in the past week. We also found that half of PPI users have persistent symptoms. Given the significant effect of GERD on quality of life, further research and development of new therapies are needed for patients with PPI-refractory GERD symptoms.
