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Makara J. Health Res.

, 2016, 20(2): 35-40
doi: 10.7454/msk.v20i2.5740

The Prevalence and Risk Factors of GERD among Indonesian Medical Doctors

Ari F Syam1*, Florentina CP Hapsari2, Dadang Makmun1

1. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia,
Jakarta 10310, Indonesia
2. Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10310, Indonesia

Background: Based on our knowledge, the study of gastrointestinal reflux disease (GERD) among certain profession
has never been conducted. The aim of this study is to determine the prevalence and risk factors of GERD among
Indonesian doctors. Methods: A consecutive study involving 515 doctors was conducted in October 2015. The GerdQ
score was used to the diagnosis of GERD and determined its impact on daily life. All possible risk factors were also
analysed. Results: A total of 515 subjects completed the questionnaire. The mean age of them was 41.37 ± 11.92 years
old. Fifty-five percent of them were male and 60.6% general practitioners. The prevalence of GERD was 27.4% of
which 21.0% was had GERD with low impact on daily life, and 6.4% was GERD with high impact on daily life. The
statistically significant risk factors of GERD was found in age >50 y.o (p = 0.002; OR = 2.054), BMI >30 kg/m2 (p =
0.016; OR = 2.53), and smokers (p = 0.031; OR = 1.982). Sex and education level were not found significant
statistically as the risk factors of GERD. Conclusions: The prevalence of GERD among Indonesian physician was
27.4%. We found that age over 50 y.o, obesity and smoking habit were the risk factors of GERD in Indonesian doctors.

Keywords: GERD, physicians, prevalence, risk factors

Introduction Eighty percent of GERD symptoms may be persistent,
and it implicates to increase the risk of several
Gastroesophageal reflux disease (GERD) is one of the complications such as oesophagal ulcer, oesophagal
common gastrointestinal problems worldwide with a stricture, Barrett's oesophagus, and adenocarcinoma.8,9
range of GERD prevalence was 18.1-27.8% in North Moreover, the persistent symptoms can reduce the work
America, 23.0% in South America, 8.8-25.9% in productivity and quality of life.10
Europe, 11.6% in Australia and 8.7-33.1% in the Middle
East. Lower prevalence was found in East Asia region, The GERD diagnosis can be established in the setting of
ranging from 2.5 to 7.8%.1 Several studies in Iran typical symptoms of heartburn and regurgitation.11
population reported the prevalence of GERD was 6.3- Many studies develop easier tools to help the physicians
18.3%. Also, a study in Pakistan showed higher in the diagnosing patient with GERD symptoms. The
prevalence, 24.0%.2,3 Even the prevalence in East Asia most recent instrument was GERD Questionnaire
region was relatively low, a hospital-based study in (GerdQ) which was created from three different
Indonesia found the prevalence of GERD among validated questionnaires evaluated in the DIAMOND
dyspeptic patient who underwent endoscopic procedure study.12,13 GerdQ has been used worldwide as an easy
was 32.4%, higher.4 Time trend studies have also way to predict the probability of GERD in patients with
reported the increase of GERD prevalence.2 gastrointestinal symptoms. Validation study of GERDQ
in the Indonesian language has been done before which
GERD is known as a condition caused by abnormal showed that Indonesian version of GERDQ is reliable to
reflux of gastric contents into the oesophagus so that the be used to diagnose GERD based on the reported
patients may complain heartburn, a burning sensation in symptoms with the same cut-off point.6
the middle of the chest, and regurgitation, a moving
upward sensation of stomach content. The inappropriate Medical doctor has been known as one of high work-
lower oesophagal sphincter closure categorised as the hour professions, with a range of 51 to 67 hours per
cause of gastric contents reflux.5,6 Besides the week from various studies.14-16 The general practitioner,
gastrointestinal symptoms, GERD can also manifest in internal medicine resident, and internal medicine
vary analysed oesophagal symptoms, such as dysphasia, specialist and subspecialist work for long hours in a
chronic cough, laryngitis, and asthma-like-symptoms.7 quite stressful environment and spend most of their time

35 August 2016 | Vol. 20 | No. 2

21 The GERDQ is a simple communication tool to relieve the symptoms at least once a week. and 6.0 for windows. Universitas Indonesia.41 kg/m2. The subjects fulfilled questionnaire containing demographic Basic characteristics. The potential burnout. People who mass index (BMI) was 23. at least once a week. the standard of deviation (SD).6% of subjects Faculty of Medicine. meanwhile regurgitation questionnaire has been developed from three established was found in 15% of subjects for the same frequency. where a more frequent of symptoms. We also analysed the demographic mention above.62 ± 4.6. ethnic. weight. high body difficulties due to heartburn and regurgitation. Gastrointestinal Symptom Rating Scale. ethnicity and H. The GerdQ consists of six questions about related Risk factors of GERD.19 Besides. pylori infection can also be the factors that Data analysis. The mean of age was 41. et al.0% was GERD GERD.0 kg/m2.18 Meanwhile. This study was groups: <30 kg/m2 and ≥30. had a GerdQ score below eight so that they oesophagal as low probability of GERD.4% was GERD with committee of the Medical Research Ethics of the high impact on daily life (Table 2). they were likely to the score. nausea. The GERD Questionnaire (GerdQ). Descriptive statistics were presented as mean. 2 . heartburn and regurgitation. Study design. potential risk factors of GERD (Table 4). sleep studies reported age.4% of which 21. The heartburn and regurgitation and the Gastrointestinal Symptom Scale through Diamond symptoms implicated 35% of subjects took medication Study. Meanwhile. upper stomach pain. while fruits and vegetables were abdominal pain are the negative predictors of GERD the less likely to be eaten under stress. Our study was analysed for symptoms in the last seven days as follows: heartburn. Independent factors were analysed using characteristics and possible risk factors of GERD. and its impact on daily life. Health Res. and mass index.4% of regurgitation. education level. The protocol has been approved by the with low impact on daily life. age. GERD. Heartburn symptoms found in 17.e.17 A study in which is the score is in reverse. The BMI was classified into two Indonesia has never been conducted. We ruled out all incomplete questionnaire. All possible risk GerdQ results. General fulfilled all questions would proceed as research practitioner/bachelor graduates were found in 60. the questions about nausea and eat fast food and snack. GERD questionnaire instruments: the Reflux Disease Sleep disturbance was experienced in 27. 55. The cross-sectional study involving 515 Results medical doctors was conducted in October 2015. The demographic distribution questions (i.36 Syam. A Recent study showed that stress first and last two questions are positive predictors of and shift duty influenced the amount of daily intake GERD. August 2016 | Vol. Statistically significant was determined by p Methods value under 0. Previous regurgitation. The last two questions Bahrain also revealed that 39% of the physician being (sleep difficulty and medication history) assess the overweight and 33% obese. and the mean of body smoking habit and endoscopy history. multivariate analysis with backwards logistic regression methods.6% of subjects. height. 20 | No. A Recent study among the certain population in and proportion (%). GerdQ score was used to diagnose GERD and determined its impact on daily life. the higher among health provider.22 Total GerdQ score designed to determine the prevalence of GERD among were calculated by summing all of the scores for each Indonesian medical doctors using GerdQ as the question in the questionnaire. The prevalence of GERD in Indonesian factors were also analysed to find its association with medical doctors was 27. validated Indonesian language recruited to this study. The GerdQ is a self-assessment questionnaire that evaluates the presence The heartburn symptoms appear more frequent than of cardinal symptoms of GERD. Table 3 which has been developed for physicians to identify shows the proportion for each GerdQ question in all patients with GERD. The survey results were input and analysed contribute the prevalence of GERD.12 This subjects at least twice a week.05 with 95% confidential interval (CI).7% was male. All subjects and the rest of them were specialist and information about the subjects was confidential. pylori infection. Moreover. low prevalence of Helicobacter pylori If the total score for the last two questions (question infection can influence the prevalence rate of GERD. The subspecialist or PhD graduates. sex. then classified as the diagnostic tool. and several questions about 11.92 years old. in hospitals. it is determined the previous study. GerdQ score of studies have been proved that obesity was related to more than 8 is determined as high probability of GERD. In number 5 and 6) is more than 2 (two). As many as 515 subjects were educational level). previous influence of symptoms on daily life. sex.20 Therefore. and smoker possibly increased the risk of Makara J.37 ± GERD Questionnaire. using SPSS 22. 72.16 That kind of physician could be highly medication history to relieve the GERD symptoms. several ethnics group found to have as GERD with high impact on daily life. a lower risk of H. subjects.3% of subjects Questionnaire. and was presented in Table 1.

7) (4. BMI over 30 kg/m2 (p = 0.%) (n.6) Sex 31-40 years old 138 (76.247).9 kg/m2 171 33. OR 2.1 (regurgitation)? Others 43 8.2 23.0 a burning feeling behind 310 115 63 27 Minang 34 6.2 21-30 years old 77 (72. Basic Characteristics of Subjects multivariate analysis of GERD risk factors.56 1.0) (4.7 275 163 55 22 moving upwards to your Aceh 12 2.6 probability low impact high impact 31-40 y.063-3.3 (53.o) 41.8) (13.3) (54.3 >50 years old 67 (62.9 kg/m2 106 20.2) (52.6) Male 287 55.7 18.87+13.7) 10 (5.6) (17.9 kg/m2 152 29.8) (28. Health Res.2) Doctoral Degree/ 9 1.5 days day days days Sundanese 90 17. 23.0 Age of GERD on daily life on daily life 41-50 y. OR Mean of height (cm) 165.031.2) (22.6 (4.0) 31 (28.6 regurgitation? Ex-smoker 19 3.6) 108 (21. 95% CI 1.53. other than (65.0-24. Prevalence of GERD in Each Group of Age Age Groups Low GERD with GERD with 21-30 y.5 kg/m2 55 10.o 106 20.4 (heartburn)? Betawi 33 6. OR 2.191-5.5 in GERD Patients >30kg/m2 31 6.5-22.7) 32 (17.7 specialist nausea? (5. 20 | No.7) 10 (9. 2 . The statistically significant risk factors of GERD was found Characteristics Frequency (n) Percent (%) in age over 50 years old (p = 0.62+4.5 How often did you have Batak 41 8.694) also was showed statistical Mean of body mass significance as the risk factors of GERD.3) BMI Groups Total 374 (72.299-3. Table 5 shows the result of Makara J.4 How often did you have Bugis 16 3.1) (11.o 180 35.5) 7 (5. August 2016 | Vol.1) heartburn and/or Smoker 29 5.0) upper abdomen? Master degree/ How often did you have 30 71 145 269 194 37.o 120 23.7 How often did you have Subspecialist difficulty sleeping 374 89 31 21 Smoking habit because of your Non-smoker 467 90.3 (n.o 109 21.7 41-50 years old 92 (76.4) (10.2) (5.0-29.0 Frequency of symptoms (n.3) throat or mouth Palembang 11 2.9) (4.982.7) backwards logistic regression analysis that can show what we physician told only the statistic significant probability among the to you take? independent factors. Mean of weight (kg) 64.2) Chinese 33 6.7) (10. Frequency of Symptoms during Previous Week 25.002.92 1. The Prevalence and Risk Factors of GERD among Indonesian 37 Table 1.6 Table 3.0) 33 (6.1 stomach contents Minahasa 14 2.375).%) (n.37+11.4) <18.054.6+8.0) (19.4) 6 (5.3 How often did you have 21 60 156 278 Educational Status a pain in the centre of the Bachelor degree 312 60.3) (6.7) 21 (17.0) 24 (22.016.7 (72.6 your breastbone (60.7 How often did you take additional medication for heartburn and/or 335 100 56 24 GERD.4) (31.%) Questions 0 1 2-3 4-7 Ethnics Javanese 188 36. and smokers (p = 0.3) (12.7) (30.50 95% CI 1. 95% CI Mean of age (y.8) Female 228 44.%) >50 y.41 index (kg/m2) Table 2. Then multivariate analysis was performed using regurgitation.

24.109-4.191-5.382) Education Status Bachelor/Doctor 86 (27.4) >50 y.3-18.063-3. August 2016 | Vol.039 (0.043 (1. reported the British have more (p = 0. and The prevalence of GERD among medical doctors using 35% need medication to relieve the symptoms at least GerdQ tools 27.7) 0.27 population was 6. shift-work.26 Therefore.3) 0.29.329-5. 20 | No. This result was consistent with the previous Discussion study in Indonesia. and East Asia.38 Syam. (108 subjects) of GERD with low impact on daily life and 6. Similar to our study.365 (0.23 Lower prevalence was also found in More male (55.1% of the subjects had sleep disturbance every day.026 2.982 (1.3 Because of these symptoms. Table 4. > 50 years old. and China in this study. and 25% respectively.5) 67(61.299-3. OR = 1.694) were presented in 39.8% and 46. The prevalent GERD symptoms than South-east Asian association between GERD and gender has not shown population.2) 175(76.6) 307 (75.016 2.30 Makara J.011 (1. heartburn and regurgitation symptoms Smoker 0. obesity and smoking habit were found such as of obesity. alcohol consumption.24.6) 226(72.17.o 0.3%).7) 199(69. Most of the patients with GERD were (3. Australia.247) 6% to 26% within 5 years.3%) were included studies in India (7.054 (1.8) Age <50 y. the studies Indonesia reported that the prevalence among dyspeptic in Japan and Greece reported that male is more prevalent patients was 32.110-3.9%). Age Many factors were expected contribute to these findings. Medical doctors as one of high workload and high among medical doctors in Indonesia.3.4) 0. and obesity among health Europe.o 100 (24.8) >30 kg/m2 14 (45.1) Table 5.2) 357 (73.o 42 (38. Japan (1. higher than our findings.4%. Iran.2) PhD/Subspecialist 3 (33. et al.2. The Association of GERD and Several Possible Risk Factors Characteristics GERD (n.4% of GERD with high impact on daily life.9) 346(74.460 (0.982-2.002 2.7%) than female (44.53 (1.28 On the contrary.6%-16.315 (1. the study in Chinese due to both ethnic differences and environmental population did not show any significant difference in influences.%) Non-GERD (n.7) 28 (58.25 A comparative study conducted by male (88/62.171).195-3. some studies reported America but higher than the findings in South America. A hospital-based study in Jakarta revealed an increasing trend of GERD prevalence from Age >50 y. Health Res.6%).061 1.4 It might than female.982-2. Result of Multivariate Analysis of GERD Risk be due to the study was conducted only among Factors dyspeptic patients while our study was conducted in the Variables p OR (CI 95%) general population.759) Non Smoker 121 (25.3 2 BMI >0 kg/m 0. work-hour profession may potentially influence their eating habit.5) 0. 95% CI = 0. unhealthy diet. but it was not significantly difference Mahadeva et al. Though the GERD event among medical Our findings were similar to the prevalence in North doctor has not been clear. the previous study conducted in gender related to GERD.3) 0.832) Smoking Habit Smoker 20 (41.659) Body Mass Index <30 kg/m2 127 (26.694-1.061. 4.035 2.%) p (CI 95%) OR (CI 95%) Sex Male 88 (30.0%.555) Master/Specialist 52 (26.375) In our study. It consists of 21% once a week.460.1%). They predicted the difference is probably consistency.6% of subjects respectively in vary frequency (from once a week to every day).031 1.008 2. and smoking statistically significant as the risk factors of GERD habit.3%.852 1.8) 0.171) Female 52 (23.3) 6(66.8) 142(73.4% (141 subjects).667 1.2) 17 (54.1. and Korea reported GERD in the event. 2 .1 Similar study in profession that might be contributing to the GERD Pakistan.

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