Why differences between New York and New Delhi matter in approach to gastroesophageal reflux disease

Abstract

Despite rising worldwide prevalence of gastroesophageal reflux disease (GERD), conclusive diagnosis of clinically significant GERD remains elusive, both in New York and in New Delhi. GERD is unique in that diagnosis and management are pursued simultaneously, and indeed, the same diagnostic approach can also be therapeutic, e.g. the proton pump inhibitor (PPI) trial. Currently available tools for GERD diagnosis rely on subjective clinical historyorquestionnairedata,complementedbyobjectivemeasuresof macroscopic and microscopic mucosal integrity, reflux burden, and esophageal pathophysiology. Consequently, GERD management is nuanced and tailored based on patient factors and each physician's approach to diagnosis, which is unique to each region of the world. However, these diagnostic modalities alone are insufficient for a conclusive diagnosis and must be performed and interpreted within the clinical context, with the understanding that gray areas exist. A multipronged approach increases diagnostic confidence but also requires the insight of the treating physician in choosing the diagnostic and management approach appropriate for each part of the world, hence our heavy reliance on informed consensus opinions from regional thought leaders, which is what the Indian Consensus on GERD provides [1].

Prevalence, risk factors, and healthcare‐seeking among subjects with esophageal symptoms: A community‐based study in a rural Bangladeshi population

“…There is a scarcity of such data from Asia, particularly from the rural community where most people live. Such a study is essential as the dietary, cultural, psychological, and socioeconomic factors; health‐care systems; and religious beliefs may affect symptom burden, perceptions, QoL, health‐care utilization, and treatment 12,13 . Hence, we conducted a door‐to‐door survey among a rural community of Bangladesh with the aims (i) to study the prevalence of heartburn, chest pain, globus, and dysphagia of presumed esophageal origin; (ii) to study the prevalence of esophageal disorders of presumed functional origin based on Rome III criteria; (iii) to determine the risk factors for esophageal symptoms; and (iv) to determine the consultation rate, medications use, and QoL issues among the subjects with esophageal symptoms.…”