Asian Patients Report Higher Reflux Symptom Burden than US Patients Despite Lower Objective Reflux Burden

Area of Science:

• Gastroenterology
• Digestive Health
• Clinical Research

Background:

• Gastroesophageal reflux disease (GERD) symptom experience and objective reflux burden can differ across global populations.
• Understanding these variations is crucial for accurate diagnosis and effective management of GERD.

Purpose of the Study:

• To investigate the relationship between symptom profiles and objective measures of reflux burden in GERD patients from Asia and the United States.
• To compare GERD characteristics between Asian and US patient cohorts.

Main Methods:

• A cross-sectional study involving 1099 patients undergoing pH-impedance monitoring across one Asian and two US centers.
• Prospective collection of validated patient-reported symptom instruments and comparison with objective reflux parameters (AET, TRE, MNBI).

Main Results:

• Asian patients (n=162) presented with predominant regurgitation and higher total reflux episodes (TRE) but lower acid exposure time (AET), mean nocturnal baseline impedance (MNBI), and conclusive GERD rates per Lyon 2.0 compared to US patients (n=937).
• Despite lower objective reflux burden, Asian patients reported higher symptom burden (GERDQ, GSS).
• Adjusting the AET threshold to 4% improved diagnostic yield in Asian patients. Asian ethnicity, higher AET, higher reflux episodes, lower BMI, and female sex were independent predictors of higher global symptom severity (GSS).

Conclusions:

• GERD patient profiles in Asia are characterized by increased symptom reporting relative to objective reflux burden when compared to US patients.
• These findings highlight significant regional disparities in GERD presentation and underscore the need for population-specific diagnostic criteria or interpretations.