ABSTRACT Background Symptoms and reflux burden in gastroesophageal reflux disease ( GERD ) may vary between populations. Aims To evaluate relationships between symptom profiles and objective reflux burden in patients in two world regions, Asia and the United States. Methods This was a cross‐sectional study of patients undergoing pH ‐impedance monitoring from one Asian and two US centres. Validated patient‐reported symptom instruments were prospectively collected. Symptom characteristics were compared against objective reflux burden (acid exposure time, AET ; total reflux episodes, TRE ; mean nocturnal baseline impedance, MNBI ) from pH ‐impedance monitoring between the two populations. Results Of 1099 patients, 162 were in Asia (age 47.4 ± 1.1 years, 36.4% female, body mass index, BMI 24.2 ± 0.4 kg/m 2 ) and 937 in the United States (53.1 ± 1.3 years, 67.7% female, BMI 30.1 ± 0.3 kg/m 2 ). Regurgitation dominated in Asia (59.9% vs. 50.3% heartburn in the United States), with higher TRE (55.4 ± 2.4 vs. 46.4 ± 1.2, p < 0.001). Despite this, reflux burden was lower in Asia (mean AET 2.19% ± 0.4% vs. 3.53% ± 0.2%; pathologic AET 11.1% vs. 20.5%; MNBI 2472 ± 62 Ω vs. 1745 ± 81 Ω; conclusive GERD per Lyon 2.0: 13% vs. 25.7%) (all p < 0.001), with higher symptom burden (GERDQ 8.97 ± 0.2 vs. 8.44 ± 0.1, p < 0.05; global symptom severity, GSS: 65.1 ± 1.8 vs. 48.1 ± 1.1, p = 0.001). Changing the AET threshold to 4% increased diagnostic yield by 21% among Asians ( p = 0.035 vs. US). On multivariable linear regression, Asian patients (β = 19.3, p < 0.0001), higher AET (β = 1.02, p = 0.0004), higher reflux episodes (β = 0.11, p = 0.0029), lower BMI (β = −0.37, p = 0.0046) and female sex (β = 8.14, p = 0.0007) were independent predictors for higher GSS. Conclusions Compared to US patients, GERD profiles in Asian patients associate with higher symptom reporting despite lower objective reflux burden.
Chan et al. (2026) studied this question.