GERD symptoms and risk-factors among multinational medical students

Grune Nilaja E., Alcantra Guylain G.

Grune Nilaja E., Tbilisi State Medical University, medical student, 7 Mikheil Asatiani St, Tbilisi, Georgia. Alcantra Guylain G., Tbilisi State Medical University, medical student, 7 Mikheil Asatiani St, Tbilisi, Georgia

GERD symptoms and risk-factors among multinational medical students

Grune Nilaja E., Alcantra Guylain G.

Correspondence to: Grune Nilaja nilly_EBUN@hotmail.com

Abstract:

Introduction: Gastro-esophageal reflux disease (GERD) is a largely extended disease which is related to different risk-factors such as: nutritional patterns, smoking and obesity. The aim of the research was to determine the prevalence of GERD symptoms (heartburn & regurgitation) and its relationship with GERD risk factors among Tbilisi State Medical University’s multinational medical students. A case-control study was conducted among 148 medical students, who were divided into two groups. The first consisted of 84 international students (mean age 22 ±3.41) and the second of 64 Georgian students (mean age 21 ±1.37). To determine the presence of GERD symptoms a questionnaire based on the Montreal criteria was used.

Statistical method: Continuous variables are presented as mean (M) ± standard deviation (SD). Strength of associations within the subject groups was expressed as odds ratio (OR) and the statistical significance was defined as p < 0.05. Calculations were done with Microsoft excel 2013.

Discussion: The prevalence of GERD symptoms (heartburn & regurgitation) within the Georgian group was 35.9% and 34.5% within the international group, respectively. Among the international students we noticed an association between tobacco smoking (OR= 8.4, p≤0.05), alcohol consumption (OR= 4.2, p≤0.05), salty food (OR= 3, p≤0.05) and the development of GERD symptoms. Among the Georgian students consumption of spicy food (OR=9.1, p≤0.05) and caffeinated beverages (OR=3.4, p≤0.05) were associated with the development of the GERD symptoms.

Conclusion: Although the prevalence of GERD-symptoms is nearly equal among the international and Georgian students, the GERD risk factors in both groups differ greatly and require different preventive approaches. Further analysis for the correlation between lifestyle and the specific symptoms should be conducted.

Introduction

Gastro-esophageal reflux disease is a digestive disorder affecting the lower esophageal sphincter allowing stomach acid and/or contents to flow back up into the esophagus. This retrograde movement can cause adverse esophageal- and extra-esophageal syndromes.

Complications of GERD include reflux esophagitis, Barret’s esophagitis and esophageal adenocarcinoma. The extra-esophageal syndromes can lead to cough, laryngitis, dental erosions and asthma⁽⁸⁾.

Epidemiology

Worldwide, prevalence of GERD is higher in Western countries (15-25%) than in Eastern countries (3%-16%), the reason for these differences might be associated with obesity and dietary factors. A difference in symptoms prevalence does exists with western countries predominantly reporting more heartburn and eastern countries reporting more regurgitation as typical GERD symptoms.⁽²⁾ A study conducted in the USA showed a racial difference in prevalence rates of GERD, in which Hispanics had the highest rates followed by Caucasians, African-Americans and Asians.⁽³⁾

Diagnostic criteria

According to the Montreal criteria, the characteristic symptoms of typical GERD are more than 2 episodes of heartburn and regurgitation per week, although heartburn with or without regurgitation is the first basic diagnostic sign.^(1,8) Epigastric pain might also be a major sign, because of the existing association between the seizing of heartburn and epigastric pain after the use of PPI’s: ⁽¹⁾

Dietary factors

Studies observing different diets and their effect on development of GERD are still sparse. The existing studies reveal an association between the consumption of salted food, fatty foods, chocolate and carbonated soft drinks and the development GERD. No association between alcohol and GERD have been found, but smoking more than 6 packs of cigarettes per day has been listed as an independent risk factor. The speed at which food is being consumed is another risk factor and eating frequent, small amounts of food slowly should be recommended.^(4,6,7)

GERD in Georgia

Insufficient studies have been conducted to determine the prevalence of GERD and GERD-related syndromes in the Republic of Georgia. The World Health Organization (WHO) ranked Georgia as one of the highest tobacco consuming countries in the European region and the world, with 55% male and 5% female smokers.⁽¹⁰⁾

According to a Global Youth Tobacco Survey (GYTS) conducted in 2014 under the aegis of the WHO, 42% of respondents were under the second-hand tobacco smoking at home and 55% of respondents were affected by second-hand tobacco smoke in public areas.⁽¹⁰⁾Alcohol consumption level in Georgia was not considered problematic.⁽¹⁰⁾

GERD-symptoms among TSMU students

The aim of this research was to determine the prevalence of GERD symptoms (heartburn & regurgitation) and its relationship with the GERD risk factors among Tbilisi State Medical University’s multinational medical students.

Methodology

A case-control study was conducted among 148 medical students, who were divided into two groups. The first consisted of 84 international students (mean age 22 ±3.41) and the second of 64 Georgian students (mean age 21 ±1.37). The first group consisted of students from: India (57%), Nigeria (17%), Sri Lanka (9.5%) and minorities (13.2%). The second group consisted mainly of Georgian students (95%). See figure1

To determine the presence of GERD symptoms a questionnaire based on the Montreal criteria was used. Lifestyle related questions were also included such as: alcohol consumption, smoking and diet. See figure 4

Statistical method

In this categorical study, continuous variables were presented as mean (M) ± standard deviation (SD) and non-continuous variables as proportion (%). Strength of associations was expressed as odds ratio (OR) and variables which revealed (OR)> 1 and p ≤ 0.05 were considered to be significant. Two sample proportional Z-test was used to compare the proportions between the two subject groups and p≤.0.05 was considered significant. Calculations were made with Microsoft excel 2013.

Results

The proportion of GERD symptoms (heartburn & regurgitation) within the Georgian group was 35.9% and 34.5% within the international group, respectively. A difference in symptom presentation was noticed between these groups. Within the group of International students 54.2% mainly presented with both heartburn and regurgitation and 25% only regurgitation, while the group of Georgian students mainly experienced both heartburn and regurgitation (51.7%) or only heartburn (27.6%). See figure (2, 3)

An association between the development of GERD symptoms and dyspepsia (OR=5.1, P≤0.05), epigastric pain (OR=5.3, P≤0.05) and globus sensation (OR=19.6, P≤ 0.05) was noticed within the group of international students. The group of Georgian revealed only an association between the GERD- symptoms and dyspepsia (OR=3.6, P≤ 0.05). See table 1.

The international students reported a significantly higher relationship between the presence of the disease symptoms and certain lifestyle habits, compared to the control group. These lifestyle habits were: tobacco smoking (OR= 8.4, p≤0.05), alcohol consumption (OR= 4.2, p≤0.05) and the consumption of food with a high salt content (OR= 3, p≤0.05).

In the group of Georgian students a significantly higher relationship was noticed between the consumption of spicy food (OR=9.1, p≤0.05) and caffeinated beverages (OR=3.4, p≤0.05).See table 2

Between the international and Georgian group not enough evidence was present to predict the occurrence of a proportional difference for Tobacco smoking, alcohol consumption, spicy food, salty food and caffeinated beverages. See table 3

Conclusion

The results of this study revealed a nearly equal prevalence of GERD symptoms (heartburn & regurgitation) among both Georgian and international students but different risk factors that contributed to the development of these symptoms. The risk factors for the international students were: Tobacco smoking, alcohol consumption and salty food intake. The risk factors for the Georgian students were: intake of Spicy food and caffeinated beverages. In each group different preventive approaches are therefore required for successful management of GERD and symptoms. A possible explanation for the absence of tobacco smoke as a risk factor among the Georgian participants might be a lower total exposure (smoking habits; younger mean age). A difference in symptom presentation has also been noticed and should be taken into consideration for diagnostics. The International students presented with more regurgitation while the Georgian students suffered predominantly from heartburn.

The difference in prevalence for these aforementioned risk factors is unlikely to reoccur. Further study should be conducted on a larger scale to reveal the exact correlation between the different lifestyle risk-factors and GERD-symptoms.

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