Gastro-oesophageal reflux diseases in Chinese
Abstract of thesis entitled Gastro-oesophageal reflux disease in Chinese Submitted by Wong Wai Man, Raymond for the degree of Doctor of Philosophy at The University of Hong Kong in 2004
The aims of this thesis were 1) to study the population and endoscopic prevalence of gastro-oesophageal reflux disease (GERD) and non-cardiac chest pain (NCCP); 2) to study the pathophysiology of GERD; 3) to evaluate upper gastrointestinal investigation of NCCP; 4) to validate a diagnostic GERD questionnaire; 5) to study the optimal dose of proton pump inhibitor (PPI) for the treatment of GERD in Chinese.
A population-based telephone survey was performed to study the prevalence of GERD and NCCP, and the effect of anxiety and depressio n on health care utilisation in Chinese. The annual, monthly and weekly prevalence of GERD were 29.8%, 8.9% and 2.5% respectively. NCCP was present in 13.9% of subjects. GERD was associated with anxiety, depression, medical consultation, sick leave, and adverse effects on social life. The frequency of heartburn, the degree of depression, female gender and ?eeling compromised social life?were independent factors associated with health care utilisation in GERD. Female gender, presence of GERD, and ?eeling compromised social life?were independent factors associated with health care utilisation in NCCP.
The endoscopic prevalence of oesophagitis, hiatus hernia, benign oesophageal stricture and Barrett? oesophagus were 3.8%, 1.7%, 0.08% and 0.06% respectively in a prospective study of 16,606 Chinese. Most patients were having a milder form of disease (LA grade A/B severity). Advanced age, use of nasogastric tube and gastrointestinal bleeding were associated with poor long-term outcome.
We then evaluated the usefulness of upper gastrointestinal investigation for NCCP in Chinese. Upper endoscopic pathology was present in 10% of patients. Typical acid reflux symptoms are uncommon in Chinese NCCP patients but abnormal oesophageal acid exposure was found in 29% of patients. Ineffective contractions were more frequently found in NCCP patients by 24-hour ambulatory manometry, which may have a bearing on the impaired quality of life in such patients.
The major pathophysiological mechanism of GERD in Chinese has not been studied before. We demonstrated that the frequency of transient lower oesophageal sphincter relaxations (TLESRs) was similar between GERD patients and controls. TLESRs accounted for majority of acid reflux episodes in both GERD patients and controls. Primary peristalsis was significantly impaired in Chinese patients with GERD, suggesting oesophageal motor dysfunction may play a role in the pathophysiology of GERD in Chinese.
There is no direct translation of the word ?eartburn?in Chinese. No validated GERD symptom score exists in Chinese language. We have demonstrated that a 7- item GERD questionnaire has a sensitivity of 82% and a specificity of 84% for the diagnosis of GERD in Chinese. It could be used in epidemiological studies and interventional studies of GERD in Chinese.
Proton pump inhibitor (PPI) is the most effective treatment for the initial and maintenance treatment of GERD. The optimal dosage of PPI for the treatment of GERD in Chinese remained to be defined. We have demonstrated that lansoprazole 30mg and lansoprazole 15mg once daily provide satisfactory reduction in oesophageal acid exposure, comparable improvement in symptoms profile and quality of life, and were equally effective in treating GERD in Chinese.
School:The University of Hong Kong
School Location:China - Hong Kong SAR
Source Type:Master's Thesis
Keywords:gastroesophageal reflux china hong kong pathophysiology treatment proton pump inhibitors
Date of Publication:01/01/2004