Original contribution
Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study

https://doi.org/10.1016/S0002-9270(01)03242-7Get rights and content

Abstract

OBJECTIVE:

Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community-based studies are sparse, and long-term natural history data are unavailable. We aimed to determine the natural history of these conditions.

METHODS:

A representative Swedish sample (20–79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively; 79% responded to all three mailings).

RESULTS:

The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (<10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in ≥90% of cases.

CONCLUSION:

There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD.

Introduction

Many persons in the Western world are troubled by abdominal pain or bowel habit disturbances; such complaints are reported by up to one in two people in cross-sectional population-based studies 1, 2, 3, 4. Functional upper and lower GI symptoms have been grouped by investigators into several syndromes based on clinical experience, including symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) (5). Depending on the definitions applied, the prevalence observed in previous population-based studies for GERD has ranged on average from 15% to 25% 6, 7, 8, 9, 10, whereas for dyspepsia the prevalence has been 15% to 40% 1, 3, 11, 12, 13, and for IBS 10% to 20% 13, 14, 15.

Irrespective of the definition used, the societal costs of these conditions are considerable 16, 17, although only a fraction of all sufferers seek medical care each year 3, 18, 19, 20, 21, and some never do 20, 22. Up to one in 20 of all consultations in primary health care are for dyspepsia 23, 24, and prescription rates of over 90% have been reported in general practice 16, 25. One third of the consulters are sooner or later referred to a specialist (26), and functional abdominal disorders constitute up to one third of all consultations to gastroenterologists (27). We also know that many of the drugs used are unhelpful 28, 29, 30. Detailed data on the long-term natural history of the functional GI disorders are lacking, yet such knowledge is vital. Identifying who with functional abdominal disorders will continue to have chronic symptoms and who will lose or change their symptoms would aid in planning interventions.

Symptoms of reflux in outpatients are known to persist for at least 10 yr in up to three quarters of patients (31). Similarly, symptoms in patients with functional dyspepsia (32) and IBS are usually chronic 33, 34. However, these observations are based on small numbers of persons who have sought health care, which may be attributable to selection bias as most subjects with these conditions are not consulters (20). Little population-based data are available on the natural history of the functional GI disorders. In particular, there remains a lack of long-term follow-up population-based data.

In this study, we aimed to explore the long-term natural history of symptomatic GERD, dyspepsia, and IBS in a randomly selected general population. The prevalence, symptom stability over time within each of these symptom groups, and the change in main symptom profile over time was studied by means of a validated questionnaire mailed to the same population on three occasions over 7 yr.

Section snippets

Setting

In January, 1988, the municipality of Östhammar had 21,338 inhabitants living in either urban (67%) or rural (33%) areas. The distribution by age, gender, family size, income, occupational category, and other socioeconomic variables was similar to the national average (35), and 96% of the residents were Swedish citizens.

Sampling

By using the computerized national population register, a representative sample was drawn (February, 1988), consisting of all Swedish citizens born between 1909 and 1969 (i.e.,

Demographic data

There were no statistically significant differences in mean age and gender distribution between all responders in the three surveys, and the 843 who were responders to all three questionnaires (Table 1). Among these 843 persons, there were 397 (47.1%) men and 446 (52.9%) women [reflecting the pattern in the Swedish population (42)]. The results suggest that there was no sampling bias.

Prevalence of symptom profiles in the three samples

The 3-month period prevalence of the symptom profiles in each of the studies is shown in Table 2. More than half

Discussion

To our knowledge, this is the first report of the natural history of symptomatic GERD and functional GI disorders in a representative population with three observation points over 7 yr. It confirms that abdominal disorders are highly prevalent in the community. GERD had a stable prevalence over 7 yr, whereas the prevalence of dyspepsia based on criteria similar to Rome II (43) decreased with advancing age. IBS increased with age as well as over time irrespective of aging. Although there was a

Acknowledgements

This study was supported in part by The Medical Faculty of Uppsala University and Uppsala County Council, Sweden. We thank Nicci Keeling for assistance with Figure 2.

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