Gastroesophageal Reflux Disease (GERD) in the East—Same as the West

Gastroesophageal reflux disease (GERD) is basically the same disease in the East as in the West. Although it is one of the most common illnesses in Western patients, GERD is still comparatively uncommon in the East. Furthermore, Asian patients with GERD often exhibit milder disease with lower prevalence of complications including Barrett esophagus. Recent data, however, indicate that it is an emerging disease in Asia and its increase in prevalence seem to be a time lag phenomenon when compared with the West. Pathophysiologic factors in Asian patients have been noted to be the same as in Western patients except on a lower magnitude. A lower acid secreting capacity has been reported in Chinese patients and low dietary fat and reduced obesity may account for better gastric emptying and decreased transient lower sphincter relaxations. The high Helicobacter pylori prevalence in the East may also account for lower acid secretion and consequent milder GERD. Heartburn, which is the cardinal symptom of GERD in the West may not be present in Asian patients who may in fact, complain with nonspecific chest discomfort and labeled as having noncardiac chest pains. Extra esophageal manifestations in Asian patients have not been well studied but available data suggest that it is not uncommon. Treatment practices in the East are similar to the West. Proton pump inhibitors are widely prescribed, but its use is often limited by cost as patients are often not insured and are “self paying.” Surgery and endoscpic therapy for GERD are not commonly carried out.