Skip to main content
Top
Published in: BMC Gastroenterology 1/2018

Open Access 01-12-2018 | Research article

Gastroesophageal reflux symptoms among Italian university students: epidemiology and dietary correlates using automatically recorded transactions

Authors: Irene Martinucci, Michela Natilli, Valentina Lorenzoni, Luca Pappalardo, Anna Monreale, Giuseppe Turchetti, Dino Pedreschi, Santino Marchi, Roberto Barale, Nicola de Bortoli

Published in: BMC Gastroenterology | Issue 1/2018

Login to get access

Abstract

Background

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders worldwide, with relevant impact on the quality of life and health care costs.The aim of our study is to assess the prevalence of GERD based on self-reported symptoms among university students in central Italy. The secondary aim is to evaluate lifestyle correlates, particularly eating habits, in GERD students using automatically recorded transactions through cashiers at university canteen.

Methods

A web-survey was created and launched through an app, ad-hoc developed for an interactive exchange of information with students, including anthropometric data and lifestyle habits. Moreover, the web-survey allowed users a self-diagnosis of GERD through a simple questionnaire. As regard eating habits, detailed collection of meals consumed, including number and type of dishes, were automatically recorded through cashiers at the university canteen equipped with an automatic registration system.

Results

We collected 3012 questionnaires. A total of 792 students (26.2% of the respondents) reported typical GERD symptoms occurring at least weekly. Female sex was more prevalent than male sex. In the set of students with GERD, the percentage of smokers was higher, and our results showed that when BMI tends to higher values the percentage of students with GERD tends to increase. When evaluating correlates with diet, we found, among all users, a lower frequency of legumes choice in GERD students and, among frequent users, a lower frequency of choice of pasta and rice in GERD students.

Discussion

The results of our study are in line with the values reported in the literature. Nowadays, GERD is a common problem in our communities, and can potentially lead to serious medical complications; the economic burden involved in the diagnostic and therapeutic management of the disease has a relevant impact on healthcare costs.

Conclusions

To our knowledge, this is the first study evaluating the prevalence of typical GERD–related symptoms in a young population of University students in Italy. Considering the young age of enrolled subjects, our prevalence rate, relatively high compared to the usual estimates, could represent a further negative factor for the future economic sustainability of the healthcare system.
Appendix
Available only for authorised users
Footnotes
1
The 3 levels of obesity were aggregated due to the reduced number of observations
 
Literature
1.
go back to reference Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R. The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101(8):1900.CrossRefPubMed Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R. The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101(8):1900.CrossRefPubMed
2.
go back to reference Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP, et al. Expert consensus document: Advances in the physiological assessment and diagnosis of gerd. Nat Rev Gastroenterol Hepatol. 2017; 14(11):665.CrossRefPubMed Savarino E, Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP, et al. Expert consensus document: Advances in the physiological assessment and diagnosis of gerd. Nat Rev Gastroenterol Hepatol. 2017; 14(11):665.CrossRefPubMed
3.
go back to reference Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, et al. Burden of gastrointestinal disease in the united states: 2012 update. Gastroenterology. 2012; 143(5):1179–87.CrossRefPubMedPubMedCentral Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, et al. Burden of gastrointestinal disease in the united states: 2012 update. Gastroenterology. 2012; 143(5):1179–87.CrossRefPubMedPubMedCentral
4.
go back to reference El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007; 5(1):17–26.CrossRefPubMed El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2007; 5(1):17–26.CrossRefPubMed
6.
go back to reference Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the hunt study. Gut. 2012; 61:2011.CrossRef Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the hunt study. Gut. 2012; 61:2011.CrossRef
7.
go back to reference Savarino E, de Bortoli N, De Cassan C, Della Coletta M, Bartolo O, Furnari M, Ottonello A, Marabotto E, Bodini G, Savarino V. The natural history of gastro-esophageal reflux disease: a comprehensive review. Dis Esophagus. 2017; 30(2):1–9.PubMed Savarino E, de Bortoli N, De Cassan C, Della Coletta M, Bartolo O, Furnari M, Ottonello A, Marabotto E, Bodini G, Savarino V. The natural history of gastro-esophageal reflux disease: a comprehensive review. Dis Esophagus. 2017; 30(2):1–9.PubMed
8.
go back to reference Castell DO, Murray J, Tutuian R, Orlando R, Arnold R. Review article: the pathophysiology of gastro-oesophageal reflux disease- oesophageal manifestations. Aliment Pharmacol Ther. 2004; 20(s9):14–25.CrossRefPubMed Castell DO, Murray J, Tutuian R, Orlando R, Arnold R. Review article: the pathophysiology of gastro-oesophageal reflux disease- oesophageal manifestations. Aliment Pharmacol Ther. 2004; 20(s9):14–25.CrossRefPubMed
9.
go back to reference Bortoli N, Ottonello A, Zerbib F, Sifrim D, Gyawali CP, Savarino E. Between gerd and nerd: the relevance of weakly acidic reflux. Ann N Y Acad Sci. 2016; 1380(1):218–29.CrossRefPubMed Bortoli N, Ottonello A, Zerbib F, Sifrim D, Gyawali CP, Savarino E. Between gerd and nerd: the relevance of weakly acidic reflux. Ann N Y Acad Sci. 2016; 1380(1):218–29.CrossRefPubMed
10.
go back to reference Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016; 14(2):175–82.CrossRefPubMed Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016; 14(2):175–82.CrossRefPubMed
11.
go back to reference Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008; 135(4):1383–91.CrossRefPubMed Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008; 135(4):1383–91.CrossRefPubMed
12.
go back to reference Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008; 135(4):1392–413.CrossRefPubMed Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008; 135(4):1392–413.CrossRefPubMed
13.
go back to reference Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013; 108(3):308.CrossRefPubMed Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013; 108(3):308.CrossRefPubMed
14.
go back to reference DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100(1):190.CrossRefPubMed DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100(1):190.CrossRefPubMed
15.
go back to reference Martinucci I, de Bortoli N, Savarino E, Nacci A, Romeo SO, Bellini M, Savarino V, Fattori B, Marchi S. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chron Dis. 2013; 4(6):287–301.CrossRef Martinucci I, de Bortoli N, Savarino E, Nacci A, Romeo SO, Bellini M, Savarino V, Fattori B, Marchi S. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chron Dis. 2013; 4(6):287–301.CrossRef
16.
go back to reference Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Di Biase AR, Colecchia A. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol WJG. 2009; 15(14):1690.CrossRefPubMed Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Di Biase AR, Colecchia A. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol WJG. 2009; 15(14):1690.CrossRefPubMed
17.
go back to reference Mone I, Kraja B, Bregu A, Duraj V, Sadiku E, Hyska J, Burazeri G. Adherence to a predominantly mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a south eastern european population. Dis Esophagus. 2016; 29(7):794–800.CrossRefPubMed Mone I, Kraja B, Bregu A, Duraj V, Sadiku E, Hyska J, Burazeri G. Adherence to a predominantly mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a south eastern european population. Dis Esophagus. 2016; 29(7):794–800.CrossRefPubMed
18.
go back to reference Bortoli N, Martinucci I, Savarino E, Bellini M, Bredenoord A, Franchi R, Bertani L, Furnari M, Savarino V, Blandizzi C, et al. Proton pump inhibitor responders who are not confirmed as gerd patients with impedance and ph monitoring: who are they?. Neurogastroenterol Motil. 2014; 26(1):28–35.CrossRefPubMed Bortoli N, Martinucci I, Savarino E, Bellini M, Bredenoord A, Franchi R, Bertani L, Furnari M, Savarino V, Blandizzi C, et al. Proton pump inhibitor responders who are not confirmed as gerd patients with impedance and ph monitoring: who are they?. Neurogastroenterol Motil. 2014; 26(1):28–35.CrossRefPubMed
19.
go back to reference Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T. Development of the gerdq, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009; 30(10):1030–8.CrossRefPubMed Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T. Development of the gerdq, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009; 30(10):1030–8.CrossRefPubMed
20.
go back to reference Jonasson C, Wernersson B, Hoff D, Hatlebakk J. Validation of the gerdq questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013; 37(5):564–72.CrossRefPubMed Jonasson C, Wernersson B, Hoff D, Hatlebakk J. Validation of the gerdq questionnaire for the diagnosis of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013; 37(5):564–72.CrossRefPubMed
21.
go back to reference Heckman J. Sample selection bias as a specification error. Econometrica. 1979; 47(1):153–61.CrossRef Heckman J. Sample selection bias as a specification error. Econometrica. 1979; 47(1):153–61.CrossRef
22.
go back to reference Valle C, Broglia F, Pistorio A, Tinelli C, Perego M. Prevalence and impact of symptoms suggestive of gastroesophageal reflux disease. Dig Dis Sci. 1999; 44(9):1848–52.CrossRefPubMed Valle C, Broglia F, Pistorio A, Tinelli C, Perego M. Prevalence and impact of symptoms suggestive of gastroesophageal reflux disease. Dig Dis Sci. 1999; 44(9):1848–52.CrossRefPubMed
23.
go back to reference Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet. 2013; 381(9881):1933–42.CrossRefPubMed Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet. 2013; 381(9881):1933–42.CrossRefPubMed
24.
go back to reference Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. Jama. 2003; 290(1):66–72.CrossRefPubMed Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. Jama. 2003; 290(1):66–72.CrossRefPubMed
25.
go back to reference Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg. 2009; 13(8):1440–7.CrossRefPubMedPubMedCentral Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg. 2009; 13(8):1440–7.CrossRefPubMedPubMedCentral
26.
go back to reference Lagergren J. Influence of obesity on the risk of esophageal disorders. Nat Rev Gastroenterol Hepatol. 2011; 8(6):340–7.CrossRefPubMed Lagergren J. Influence of obesity on the risk of esophageal disorders. Nat Rev Gastroenterol Hepatol. 2011; 8(6):340–7.CrossRefPubMed
27.
go back to reference Nocon M, Labenz J, Jaspersen D, Meyer-Sabellek W, Stolte M, Lind T, Malfertheiner P, Willich SN. Association of body mass index with heartburn, regurgitation and esophagitis: results of the progression of gastroesophageal reflux disease study. J Gastroenterol Hepatol. 2007; 22(11):1728–31.CrossRefPubMed Nocon M, Labenz J, Jaspersen D, Meyer-Sabellek W, Stolte M, Lind T, Malfertheiner P, Willich SN. Association of body mass index with heartburn, regurgitation and esophagitis: results of the progression of gastroesophageal reflux disease study. J Gastroenterol Hepatol. 2007; 22(11):1728–31.CrossRefPubMed
28.
go back to reference Bortoli N, Guidi G, Martinucci I, Savarino E, Imam H, Bertani L, Russo S, Franchi R, Macchia L, Furnari M, et al. Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study. Dis Esophagus. 2016; 29(2):197–204.CrossRefPubMed Bortoli N, Guidi G, Martinucci I, Savarino E, Imam H, Bertani L, Russo S, Franchi R, Macchia L, Furnari M, et al. Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study. Dis Esophagus. 2016; 29(2):197–204.CrossRefPubMed
29.
go back to reference Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, Sullivan DK, Rastogi A, Bansal A, Donnelly JE, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity. 2013; 21(2):284–90.CrossRefPubMed Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, Sullivan DK, Rastogi A, Bansal A, Donnelly JE, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity. 2013; 21(2):284–90.CrossRefPubMed
30.
go back to reference Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo Jr CA. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006; 354(22):2340–8.CrossRefPubMedPubMedCentral Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo Jr CA. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006; 354(22):2340–8.CrossRefPubMedPubMedCentral
31.
go back to reference Cuddeback G, Wilson E, Orme JG, Combs-Orme T. Detecting and statistically correcting sample selection bias. J Soc Serv Res. 2004; 30(3):19–33.CrossRef Cuddeback G, Wilson E, Orme JG, Combs-Orme T. Detecting and statistically correcting sample selection bias. J Soc Serv Res. 2004; 30(3):19–33.CrossRef
32.
go back to reference Carlsson R, Dent J, Watts R, Riley S, Sheikh R, Hatlebakk J, Haug K, de Groot G, van Oudvorst A, Dalväg A, et al. Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. Eur J Gastroenterol Hepatol. 1998; 10(2):119–24.CrossRefPubMed Carlsson R, Dent J, Watts R, Riley S, Sheikh R, Hatlebakk J, Haug K, de Groot G, van Oudvorst A, Dalväg A, et al. Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. Eur J Gastroenterol Hepatol. 1998; 10(2):119–24.CrossRefPubMed
33.
go back to reference Sudman S, Bradburn NM. Effects of time and memory factors on response in surveys. J Am Stat Assoc. 1973; 68(344):805–15.CrossRef Sudman S, Bradburn NM. Effects of time and memory factors on response in surveys. J Am Stat Assoc. 1973; 68(344):805–15.CrossRef
34.
go back to reference Phillips DL, Clancy KJ. Some effects of “social desirability” in survey studies. Am J Sociol. 1972; 77(5):921–40.CrossRef Phillips DL, Clancy KJ. Some effects of “social desirability” in survey studies. Am J Sociol. 1972; 77(5):921–40.CrossRef
35.
go back to reference El-Serag H, Satia J, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005; 54(1):11–17.CrossRefPubMedPubMedCentral El-Serag H, Satia J, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005; 54(1):11–17.CrossRefPubMedPubMedCentral
36.
go back to reference Shapiro M, Green C, Bautista J, Dekel R, RISNER-ADLER S, Whitacre R, Graver E, Fass R. Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007; 25(1):93–101.CrossRefPubMed Shapiro M, Green C, Bautista J, Dekel R, RISNER-ADLER S, Whitacre R, Graver E, Fass R. Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007; 25(1):93–101.CrossRefPubMed
38.
go back to reference Colombo P, Mangano M, Bianchi P, Penagini R. Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol. 2002; 37(1):3–5.CrossRefPubMed Colombo P, Mangano M, Bianchi P, Penagini R. Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol. 2002; 37(1):3–5.CrossRefPubMed
39.
go back to reference Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Gastroenterology. 2007; 132(1):87–95.CrossRefPubMed Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Gastroenterology. 2007; 132(1):87–95.CrossRefPubMed
40.
go back to reference Nandurkar S, Locke Gr, Fett S, Zinsmeister AR, Cameron A, Talley N. Relationship between body mass index, diet, exercise and gastro-oesophageal reflux symptoms in a community. Aliment Pharmacol Ther. 2004; 20(5):497–505.CrossRefPubMed Nandurkar S, Locke Gr, Fett S, Zinsmeister AR, Cameron A, Talley N. Relationship between body mass index, diet, exercise and gastro-oesophageal reflux symptoms in a community. Aliment Pharmacol Ther. 2004; 20(5):497–505.CrossRefPubMed
41.
go back to reference Keshteli A, Haghighatdoost F, Azadbakht L, Daghaghzadeh H, Feinle-Bisset C, Afshar H, Feizi A, Esmaillzadeh A, Adibi P. Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the sepahan study. J Hum Nutr Diet. 2017; 30(6):714–23.CrossRefPubMed Keshteli A, Haghighatdoost F, Azadbakht L, Daghaghzadeh H, Feinle-Bisset C, Afshar H, Feizi A, Esmaillzadeh A, Adibi P. Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the sepahan study. J Hum Nutr Diet. 2017; 30(6):714–23.CrossRefPubMed
Metadata
Title
Gastroesophageal reflux symptoms among Italian university students: epidemiology and dietary correlates using automatically recorded transactions
Authors
Irene Martinucci
Michela Natilli
Valentina Lorenzoni
Luca Pappalardo
Anna Monreale
Giuseppe Turchetti
Dino Pedreschi
Santino Marchi
Roberto Barale
Nicola de Bortoli
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2018
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-018-0832-9

Other articles of this Issue 1/2018

BMC Gastroenterology 1/2018 Go to the issue