Sensing the Blowing Winds of Change

Gastro-esophageal reflux disease (GERD) has become a major health problem in the West, utilizing extensive amounts of health resources. It affects roughly 10-20% of the general population.1 Proton pump inhibitors (PPIs) are the mainstay of its treatment and the majority of GERD patients will need to use them over the long run. Sales for PPIs are more than thirteen billion dollars a year, mostly for GERD.2 This is solely for the direct therapeutic costs of GERD, not withstanding the other costs of diagnosis, maintenance and loss in work hours. To add to the complexity of the problem is the suggested association between GERD and lower esophageal adenocarcinoma that arises in the columnar lined esophagus, or the so-called “Barrett’s esophagus”.3 Additionally, GERD substantially impacts the quality of lives of affected patients, generating much concern. In any country, the health care system will suffer significant pressure, if not well-prepared. How is the situation in the East? Population-based studies from the East indicate that prevalence of the disease is much less than that observed in the West.4 So is this disease restricted to the western countries and not a major problem in less developed countries? Recent studies indicate that the more westernization happens in different countries, the more some diseases are seen, including GERD.5 As development is a necessity of modern communities and most development necessarily brings along life style changes, it can be deduced that GERD will increase in communities where it is still uncommon; therefore, monitoring of the trends of disease becomes important for adequate and timely preparation. Do we have any information from Iran? Over the past few years several studies, including population-based studies, have addressed this issue. One of the first studies was performed by Ehsani et al. who found that about 18% of the 700 Tehran inhabitants interviewed suffered from at least weekly heartburn or acid regurgitation.6 Further studies by Pourshams et al. have reported weekly GERD symptoms in 7.5% of Tehran University freshmen (n: 3008), 10% in healthy blood donors Associate Professor, Digestive Diseases Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 1. S Nasseri-Moghaddam1*