Abstract
Background
Gastroesophageal reflux disease (GERD) is a highly prevalent and burdensome condition worldwide that significantly affects health care systems and the quality of life of patients. However, a comprehensive assessment of its global epidemiology, trends, and future projections remains limited. The aim of this study was to estimate the global, regional, and national burdens of GERD from 1990 to 2021, stratified by sex, age, and sociodemographic index (SDI) region, along with projecting its future burden up to 2050.
Methods
Using data from the Global Burden of Disease (GBD) 2021 Study, we analysed the prevalence, incidence, disability-adjusted life years (DALYs), and years lived with disability (YLDs) of GERD. Trends over time were examined using estimated annual percentage change (EAPC) analysis. Future projections were made using autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models.
Results
The global prevalence of GERD increased from 450.76 million cases in 1990 to 825.60 million cases in 2021, with an age-standardized prevalence rate (ASPR) of 9838.60 per 100,000 population in 2021 (EAPC = 0.37, 95% UI: 0.29–0.46). GERD caused 6.34 million (95% UI: 3.19–11.24) DALYs in 2021, an increase from the 3.47 million (95% UI: 1.75–6.13) DALYs in 1990, with YLDs mirroring this trend. The burden was consistently greater in females than in males. Age-specific rates peaked in the 70–74 years age group, whereas the highest absolute case numbers occurred in the 35–39 years age group. Moreover, the highest ASPR was observed in the low-middle-SDI region, with the middle-SDI region experiencing the fastest growth. By 2050, the prevalence of GERD is projected to exceed 1.2 billion cases worldwide.
Conclusion
GERD represents a growing global health burden, with disparities observed according to sex, age, and socioeconomic status. Targeted public health strategies are essential to mitigate its impact and improve disease management.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-25121-w.
Keywords: Gastroesophageal reflux disease, GBD 2021, Disability-adjusted life years, Epidemiology, Sociodemographic index, Autoregressive integrated moving average, Disease forecasting
Background
Gastroesophageal reflux disease (GERD) is a chronic, relapsing condition characterized by the backwards flow of gastric contents into the esophagus; moreover, it is among the most prevalent gastrointestinal disorders worldwide [1]. This condition is characterized by symptoms such as heartburn, regurgitation, chest pain, and chronic cough, which significantly impair the quality of life and work productivity of patients [2]. In severe cases, GERD can result in complications, including erosive esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma, thus further exacerbating its clinical and economic burdens [3]. The disease affects an estimated 10–20% of adults in Western countries, with a lower but increasing prevalence in Asia and Africa [4]. Given its chronic nature, GERD often requires long-term management, thereby leading to substantial direct costs (including costs related to medications, endoscopic evaluations, and surgical interventions) and indirect costs (including lost productivity and diminished quality of life) [5]. In addition to its economic impact, GERD significantly affects patients’ physical and mental health; moreover, severe symptoms are strongly associated with sleep disturbances, anxiety, and depression, thus increasing its societal burden [6, 7]. Despite its high prevalence and considerable public health implications, GERD remains underrecognized as a global health priority, particularly in low- and middle-income countries (LMICs), where access to diagnostic and therapeutic resources is often limited [8, 9].
The Global Burden of Disease (GBD), Injuries, and Risk Factors Study has been pivotal in quantifying health loss across various conditions. However, GERD has historically received less attention than other major noncommunicable diseases, such as cardiovascular disease and diabetes [10]. Existing epidemiological research on GERD has focused predominantly on high-income regions, whereas data from LMICs remain limited and are often derived from small-scale surveys or hospital-based cohorts that may not accurately capture the true population-level burden of the disease [11, 12]. Additionally, prior analyses have frequently relied on outdated datasets, examined GERD burden using isolated metrics (such as those based on prevalence alone), or failed to account for key sociodemographic determinants of disease distribution, including income inequality, health care accessibility, and population ageing [11, 12]. For example, although the GBD 2019 Study provided preliminary estimates of GERD burden, its scope was restricted to select regions and lacked sufficient granularity to assess temporal trends and disparities across countries [8, 11].
The increasing prevalence of GERD mirrors global trends observed for obesity, sedentary behaviour, and dietary changes, which represent key risk factors that contribute to lower oesophageal sphincter dysfunction and excessive gastric acid secretion [1, 13]. Moreover, ageing populations in high-income countries and accelerating urbanization in LMICs are reshaping the epidemiology of GERD, thus highlighting the need for updated analyses to guide prevention and management strategies [14, 15]. However, significant gaps remain in the understanding of how demographic transitions, socioeconomic development, and health care system performance collectively influence the burden of GERD. For example, although proton pump inhibitors (PPIs) remain the cornerstone of GERD treatment, their overprescription in high-income settings has elicited concerns about long-term adverse effects (such as renal impairment and osteoporosis), whereas limited access to treatment in resource-constrained regions leads to untreated disease progression [16, 17]. These disparities underscore the urgent need for a comprehensive, equity-focused assessment of the global impact of GERD.
In this study, data from the GBD 2021 Study were used to comprehensively assess the global, regional, and national burdens of GERD, which were stratified by sex, age group, group, and sociodemographic index (SDI) region. By analysing temporal trends and future projections through 2050, the aim of this study was to provide critical insights into the evolving epidemiology of GERD. Understanding the distribution and determinants of the burden of GERD is essential for guiding public health strategies, optimizing health care resource allocation, and informing targeted interventions. Moreover, the findings of this study will serve as a valuable reference for policy-makers, clinicians, and researchers in the development of evidence-based approaches to mitigate the impact of GERD on population health worldwide.
Methods
Data source
The data utilized in the present study were obtained from the GBD 2021 database (https://vizhub.healthdata.org/gbd-results/). The GBD 2021 Study comprehensively collected and evaluated the latest global burden of disease data on 371 diseases and injuries and estimated the relationships between 88 risk factors and health outcomes [18]. Crude and age-standardized estimates of various measures of the burden of GERD in 204 countries and territories from 1990 to 2021, as well as the corresponding 95% uncertainty intervals (UIs), were extracted from the GBD 2021 database. UIs were constructed using the 2.5th and 97.5th percentiles from a 1000-draw distribution for each metric [19].
For the GBD 2021 assessment, GERD was identified according to the following codes based on the 10th revision of the International Classification of Diseases (ICD-10): K21-K21.9, K22.7, and R12 [8]. These codes were selected because they encompass the primary diagnosis of GERD and its common complications as well as a key symptom (heartburn). This approach ensured a comprehensive identification of cases. The codes used were consistent with the definitions used in major clinical guidelines and previous epidemiological studies. To ensure the accuracy of the ICD-coded data, we cross-referenced the ICD-coded data with clinical information obtained from electronic health records and endoscopic reports.
The variables obtained from the database included incident cases, prevalent cases, disability-adjusted life years (DALYs), years lived with disability (YLDs) numbers, and their corresponding age-standardized rates (ASRs) at the global, regional, and national levels. These data were stratified by age (5–9 years, every 5–year age group up to 95 years, and 95 years and older), calendar year (1990–2021), region, and country (or territory). Geographically, the world was divided into 54 GBD regions. Moreover, the 204 countries and territories were categorized into five groups in terms of their SDI values: high-, high-middle-, middle-, low-middle-, and low-SDI quintiles [20].
Data handling
Data standardization
To enable comparable estimates of disease burden across regions and over time by eliminating differences in population age structures, we applied direct age standardization to all rates. The age-specific GERD burden rates were weighted according to the GBD World Standard Population structure to calculate the age-standardized rates (ASRs).
Handling of missing data
The GBD 2021 dataset used in this study employs a rigorous framework for managing missing data, which includes multiple imputation techniques and probabilistic modelling to address incomplete observations. For the GERD burden estimates, missing values were imputed using multilevel regression models that account for spatial and temporal autocorrelation, incorporating covariates such as the SDI and population age structure.
Sensitivity analyses
Sensitivity analyses were conducted to assess the robustness of our findings, including: (1) evaluating the results under different imputation scenarios (e.g., mean imputation vs. regression-based imputation); (2) testing the impact of excluding regions with high data uncertainty (defined by wide 95% UI); and (3) comparing trend estimates with and without adjustment for risk factors.
Statistical analysis
We examined the distribution characteristics of the burden of GERD both globally and across different sexes, age groups, regions and countries in 1990 and 2021. In the GBD 2021 Study, the formula for ASR calculation was as follows: 
, where 
denotes the 
th age group, 
represents the age-specific rate, and 
is the number of populations (or weights) in the corresponding age groups of the selected reference standard population [21]. All of the age-standardized rates (ASPR, ASIR, ASDR, and ASYR) are presented per 100,000 population.
The estimated average percentage change (EAPC) was calculated to profile the long-term trend in the ASRs of the burden of GERD. The formula for calculating the EAPC was as follows: 
, 
, where 
represents 
, 
denotes the calendar year, and 
is the slope obtained from the linear regression of the natural logarithm of the ASR in the specific year [22].
The projections for the burden of GERD were performed using the exponential smoothing (ES) model and the autoregressive integrated moving average (ARIMA) model. The ARIMA model excels at identifying trends and seasonality within the data, whereas the ES model focuses on recent observations, thus offering a well-rounded perspective on potential future outcomes [23]. All of the analyses were performed using R software (version 4.1.0). A P value of less than 0.05 was considered to indicate statistical significance.
Results
Global burden and temporal trends in GERD
Globally, the number of prevalent cases of GERD were 450.76 million (95% UI: 397.48–511.64.48.64) in 1990 and 825.60 million (95% UI: 732.99–925.56) in 2021 (Table 1; Fig. 1). In addition,, the age-standardized prevalence rate (ASPR) of GERD was 9616.49 (95% UI: 8427.33–10664.72.33.72) per 100,000 population in 1990 and 9838.60 (95% UI: 8732.46-11.46.46.46,056.05) per 100,000 population in 2021, with an EAPC of 0.37 (95% UI: 0.29–0.46) being observed (Figs. 2 and 3).
Table 1.
The absolute number of prevalent cases and age-standardized prevalence (ASPR) for gastroesophageal reflux disease in 1990 and 2019 and their temporal trends from 1990 to 2021
| 1990 | 2021 | EAPC (95% UI) | |||
|---|---|---|---|---|---|
| number (95% UI) | ASR (95% UI) | number (95% UI) | ASR (95% UI) | ||
| Global | 450,765,455 (397478515–511638410) | 9516.49 (8427.33–10664.72.33.72) | 825,603,654 (732989500–925555128) | 9838.6 (8732.46–11056.05.46.05) | 0.37 (0.29–0.46) |
| Sex | |||||
| Female | 236,915,528 (209576161–268133768) | 9898.36 (8782.84–11093.73.84.73) | 434,753,192 (387112710–486018857) | 10229.08 (9084.3–11502.23.3.23) | 0.06 (0.02–0.11) |
| Male | 213,849,926 (187550433–243830026) | 9130.43 (8056.67–10231.29.67.29) | 390,850,462 (344738587–439258614) | 9442.63 (8333.56–10619.85.56.85) | 0.09 (0.06–0.12) |
| Age | |||||
| 5–9 years | 146,788 (78522–246667) | 25.16 (13.46–42.27) | 174,515 (93061–292725) | 25.4 (13.54–42.61) | 0.05 (0.03–0.07) |
| 10–14 years | 3,088,258 (2016978–4450887) | 576.51 (376.52–830.88.52.88) | 3,955,761 (2592058–5725001) | 593.39 (388.83–858.79.83.79) | 0.12 (0.1–0.14) |
| 15–19 years | 16,303,937 (11662574–21944533) | 3138.85 (2245.29–4224.79.29.79) | 21,221,695 (15147612–28542138) | 3401.02 (2427.58–4574.21.58.21) | 0.21 (0.17–0.25) |
| 20–24 years | 37,006,130 (26820251–48351668) | 7520.23 (5450.3–9825.82.3.82) | 50,496,905 (36831926–65992864) | 8456.2 (6167.87–11051.15.87.15) | 0.28 (0.21–0.36) |
| 25–29 years | 49,323,636 (37122334–64569659) | 11143.57 (8386.96–14588.07.96.07) | 72,265,498 (54155937–94258971) | 12282.88 (9204.82–16021.09.82.09) | 0.3 (0.25–0.35) |
| 30–34 years | 52,124,203 (37945728–69343392) | 13523.91 (9845.23–17991.53.23.53) | 85,869,572 (62634318–113769653) | 14205.52 (10361.68–18821.07.68.07) | 0.24 (0.18–0.3) |
| 35–39 years | 51,151,664 (36876999–69281787) | 14521.64 (10469.15–19668.67.15.67) | 88,273,156 (63651067–119097142) | 15738.72 (11348.71–21234.51.71.51) | 0.25 (0.15–0.34) |
| 40–44 years | 44,219,944 (31565525–59908472) | 15435.52 (11018.34–20911.8.34.8) | 82,435,566 (59022860–110906958) | 16478.85 (11798.65–22170.27.65.27) | 0.12 (0.01–0.22) |
| 45–49 years | 37,114,494 (26840417–48600858) | 15984.16 (11559.4–20931.01.4.01) | 76,622,175 (55768217–100108266) | 16181.93 (11777.76–21141.98.76.98) | −0.05 (−0.12-0.02.12.02) |
| 50–54 years | 35,328,091 (24700941–47166130) | 16619.39 (11620.06–22188.36.06.36) | 72,584,272 (50991909–96316589) | 16313.9 (11460.84–21647.92.84.92) | −0.11 (−0.15–0.07) |
| 55–59 years | 33,085,697 (24299066–42536279) | 17864.85 (13120.45–22967.76.45.76) | 69,426,526 (51145590–88441775) | 17,544 (12924.43–22349.13.43.13) | −0.06 (−0.13-0.13) |
| 60–64 years | 29,542,988 (22374268–38453451) | 18394.33 (13930.87–23942.24.87.24) | 59,215,462 (45097299–76741151) | 18502.07 (14090.8–23978.02.8.02) | −0.08 (−0.13–0.02) |
| 65–69 years | 23,697,598 (17762072–30757684) | 19171.35 (14369.51–24882.95.51.95) | 51,587,747 (38735880–66677197) | 18701.91 (14042.77–24172.23.77.23) | −0.1 (−0.12–0.08) |
| 70–74 years | 16,608,089 (12487943–20933275) | 19617.13 (14750.5–24725.95.5.95) | 39,498,097 (29871539–49687136) | 19188.81 (14512.07–24138.81.07.81) | −0.07 (−0.1–0.04) |
| 75–79 years | 12,080,918 (9063636–15715628) | 19626.05 (14724.33–25530.82.33.82) | 25,213,585 (18894246–32808552) | 19117.94 (14326.37–24876.75.37.75) | −0.08 (−0.11–0.04) |
| 80–84 years | 6,539,387 (4773819–8643220) | 18485.42 (13494.54–24432.49.54.49) | 15,761,668 (11426423–20743198) | 17996.25 (13046.39–23684.03.39.03) | −0.1 (−0.13–0.07) |
| 85–89 years | 2,548,751 (1855982–3449526) | 16866.77 (12282.27–22827.8.27.8) | 7,385,929 (5385196–9957440) | 16154.07 (11778.18–21778.32.18.32) | −0.14 (−0.16–0.11) |
| 90–94 years | 680,299 (491673–892262) | 15875.59 (11473.79–20822.02.79.02) | 2,726,973 (1965827–3571011) | 15243.54 (10988.8–19961.63.8.63) | −0.14 (−0.15–0.13) |
| 95 + years | 174,585 (126873–229031) | 17148.34 (12461.89–22496.24.89.24) | 888,549 (646945–1174572) | 16302.72 (11869.88–21550.56.88.56) | −0.1 (−0.13–0.07) |
| SDI region | |||||
| Low SDI | 40,756,199 (35858366–46662089) | 12301.93 (10923.72–13752.96.72.96) | 96,970,987 (85122155–111319922) | 12261.34 (10889.35–13711.04.35.04) | −0.01 (−0.01-0.01) |
| Low-middle SDI | 107,823,564 (95386762–122669882) | 12526.5 (11151.33–14013.04.33.04) | 223,640,427 (198450231–253280673) | 12563.56 (11184.77–14064.75.77.75) | 0 (−0.01-0.01.01.01) |
| Middle SDI | 124,042,192 (108873698–141290275) | 8528.06 (7566.43–9556.85.43.85) | 252,457,134 (223782411–282932217) | 9314.67 (8280.55–10467.81.55.81) | 0.27 (0.24–0.3) |
| High-middle SDI | 90,575,891 (79428771–102076033) | 8413.25 (7392.13–9436.87.13.87) | 131,003,975 (115415492–146131972) | 7968.92 (7053.35–8914.06.35.06) | −0.25 (−0.32–0.17) |
| High SDI | 87,040,987 (76439203–97176618) | 8639.91 (7584.02–9703.44.02.44) | 120,765,089 (106344888–134868183) | 8379.95 (7363.75–9424.8.75.8) | −0.19 (−0.27–0.1) |
Fig. 1.
The global burden of gastroesophageal reflux disease from 1990 to 2021
Fig. 2.
World map of the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR) and age-standardized YLD rate (ASYR) for gastroesophageal reflux disease in 2021
Fig. 3.
World map for the EAPCs of the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR) and age-standardized YLD rate (ASYR) of gastroesophageal reflux disease from 1990 to 2021
Moreover, the number of global incident cases of GERD was 324.14 million (95% UI: 287.69–358.91.69.91) in 2021, increasing from 180.02 million (95% UI: 158.66–199.95.66.95) in 1990. Additionally, the age-standardized incidence rate (ASIR) increased from 3739.86 (95% UI: 3314.20–4142.33) in 1990 to 3881.86 (95% UI: 3445.56–4299.95) in 2021 per 100,000 pupulation, with an EAPC of 0.36 (95% UI: 0.29–0.43) being observed (Table 2; Fig. 2).
Table 2.
The absolute number of incident cases and age-standardized incidence (ASIR) for gastroesophageal reflux disease in 1990 and 2019 and their temporal trends from 1990 to 2021
| 1990 | 2021 | EAPC (95% UI) | |||
|---|---|---|---|---|---|
| number (95% UI) | ASR (95% UI) | number (95% UI) | ASR (95% UI) | ||
| Global | 180,018,233 (158660995–199950073) | 3739.86 (3314.2–4142.33.2.33) | 324,139,599 (287693229–358912516) | 3881.86 (3445.56–4299.95.56.95) | 0.36 (0.29–0.43) |
| Sex | |||||
| Female | 94,151,413 (83136773–104509680) | 3879.78 (3433.47–4308.62.47.62) | 169,878,817 (150535063–188377237) | 4025.55 (3563.96–4461.25.96.25) | 0.09 (0.05–0.12) |
| Male | 85,866,820 (75420551–95752172) | 3599.47 (3178.62–3991.88.62.88) | 154,260,782 (136365834–171448988) | 3737.01 (3318.13–4153.78.13.78) | 0.11 (0.08–0.14) |
| Age | |||||
| 5–9 years | 130,307 (69770–215622) | 22.33 (11.96–36.95) | 154,901 (82984–256956) | 22.55 (12.08–37.4) | 0.05 (0.03–0.07) |
| 10–14 years | 2,495,362 (1529736–3660470) | 465.83 (285.57–683.33.57.33) | 3,198,894 (1956157–4700538) | 479.86 (293.44–705.11.44.11) | 0.13 (0.11–0.15) |
| 15–19 years | 10,035,923 (6787570–14451091) | 1932.13 (1306.75–2782.14.75.14) | 13,156,096 (8866542–18931071) | 2108.42 (1420.97–3033.92.97.92) | 0.22 (0.18–0.27) |
| 20–24 years | 17,534,902 (12836359–23678135) | 3563.37 (2608.55–4811.77.55.77) | 24,002,366 (17652103–32344765) | 4019.43 (2956.02–5416.45.02.45) | 0.29 (0.22–0.37) |
| 25–29 years | 20,297,772 (14144020–26847952) | 4585.83 (3195.52–6065.69.52.69) | 29,722,567 (20801564–39356284) | 5051.91 (3535.62–6689.34.62.34) | 0.32 (0.27–0.36) |
| 30–34 years | 20,310,946 (14617312–26704155) | 5269.79 (3792.54–6928.54.54.54) | 33,522,168 (24071423–43956861) | 5545.62 (3982.17–7271.84.17.84) | 0.26 (0.2–0.32) |
| 35–39 years | 19,522,385 (13960347–26253136) | 5542.28 (3963.25–7453.1.25.1) | 33,735,409 (24227426–45233388) | 6014.88 (4319.65–8064.92.65.92) | 0.26 (0.17–0.35) |
| 40–44 years | 16,544,235 (11529048–22280695) | 5774.97 (4024.36–7777.36.36.36) | 30,834,954 (21577189–41502713) | 6163.9 (4313.27–8296.38.27.38) | 0.13 (0.03–0.22) |
| 45–49 years | 13,723,391 (9195628–18253325) | 5910.27 (3960.3–7861.19.3.19) | 28,325,529 (19040923–37494055) | 5982.1 (4021.28–7918.41.28.41) | −0.04 (−0.1-0.03.1.03) |
| 50–54 years | 13,520,147 (9286613–17626729) | 6360.28 (4368.7–8292.14.7.14) | 27,743,413 (19142940–36050677) | 6235.55 (4302.53–8102.68.53.68) | −0.1 (−0.14–0.06) |
| 55–59 years | 12,340,485 (8682887–16156927) | 6663.33 (4688.38–8724.04.38.04) | 25,879,655 (18245818–33725179) | 6539.76 (4610.7–8522.31.7.31) | −0.06 (−0.12-0.12) |
| 60–64 years | 11,097,988 (8037169–14301482) | 6909.93 (5004.18–8904.52.18.52) | 22,190,208 (16185733–28509701) | 6933.4 (5057.29–8907.95.29.95) | −0.08 (−0.13–0.02) |
| 65–69 years | 8,659,159 (6432936–11213815) | 7005.26 (5204.24–9071.97.24.97) | 18,842,751 (14039062–24323866) | 6830.99 (5089.53–8818.04.53.04) | −0.1 (−0.11–0.08) |
| 70–74 years | 5,994,000 (4205469–7780994) | 7079.99 (4967.41–9190.75.41.75) | 14,307,250 (10085176–18452514) | 6950.69 (4899.54–8964.53.54.53) | −0.06 (−0.08–0.04) |
| 75–79 years | 4,298,070 (2925237–5572472) | 6982.43 (4752.19–9052.76.19.76) | 8,990,581 (6112781–11619424) | 6817.02 (4634.95–8810.31.95.31) | −0.06 (−0.08–0.03) |
| 80–84 years | 2,285,799 (1572170–3069922) | 6461.45 (4444.18–8678) | 5,530,547 (3814862–7403567) | 6314.63 (4355.71–8453.2.71.2) | −0.08 (−0.1–0.05) |
| 85–89 years | 903,622 (650237–1194179) | 5979.87 (4303.05–7902.67.05.67) | 2,629,734 (1888909–3478314) | 5751.6 (4131.31–7607.56.31.56) | −0.11 (−0.13–0.09) |
| 90–94 years | 257,892 (180520–340318) | 6018.21 (4212.66–7941.72.66.72) | 1,036,615 (734101–1369750) | 5794.58 (4103.56–7656.78.56.78) | −0.12 (−0.14–0.11) |
| 95 + years | 65,846 (42151–95169) | 6467.65 (4140.24–9347.82.24.82) | 335,961 (214457–489013) | 6164.08 (3934.76–8972.21.76.21) | −0.1 (−0.13–0.08) |
| SDI region | |||||
| Low SDI | 16,607,902 (14551685–18469681) | 4829 (4287.06–5342.74.06.74) | 39,536,249 (34516601–44014348) | 4809.96 (4268.66–5318.34.66.34) | −0.01 (−0.01–0.01) |
| Low-middle SDI | 43,396,198 (38366263–48127013) | 4882.26 (4352.48–5408.16.48.16) | 88,397,917 (78018086–98019119) | 4894.02 (4362.32–5416.81.32.81) | 0 (0–0.01.01) |
| Middle SDI | 50,019,122 (43995351–55575248) | 3345.96 (2974.03–3704.33.03.33) | 98,388,206 (87127605–108930034) | 3660.46 (3252.07–4047.06.07.06) | 0.28 (0.26–0.31) |
| High-middle SDI | 35,652,655 (31443954–39686082) | 3293.7 (2900.96–3661.82.96.82) | 50,357,993 (44527625–55976705) | 3130.06 (2771.29–3484.45.29.45) | −0.23 (−0.3–0.15) |
| High SDI | 34,136,779 (29922481–38124824) | 3418.57 (2986.04–3815.08.04.08) | 47,166,281 (41524019–52774701) | 3353.31 (2926.72–3742.91.72.91) | −0.13 (−0.2–0.06) |
GERD is associated with 6.34 million (95% UI: 3.19–11.24) DALYs in 2021, which had increased from 3.47 million (95% UI:1.75–6.13) in 1990 (Table 3). The age-standardized DALY rate (ASDR) increased from 73.01 (95% UI: 36.75–129.66) in 1990 to 75.56 (95% UI: 38.05–133.87) in 2021 per 100,000 pupulation, with an EAPC of 0.37 (95% UI: 0.29–0.45) being noted (Fig. 3).
Table 3.
The dalys and age-standardized dalys rate (ASDR) for gastroesophageal reflux disease in 1990 and 2019 and their temporal trends from 1990 to 2021
| 1990 | 2021 | EAPC (95% UI) | |||
|---|---|---|---|---|---|
| number (95% UI) | ASR (95% UI) | number (95% UI) | ASR (95% UI) | ||
| Global | 3,472,703 (1752693–6128627) | 73.01 (36.75–129.66.75.66) | 6,336,162 (3189794–11241353) | 75.56 (38.05–133.87.05.87) | 0.37 (0.29–0.45) |
| Sex | |||||
| Female | 1,815,102 (918529–3195138) | 75.62 (38.18–133.94.18.94) | 3,314,963 (1673914–5863205) | 78.14 (39.48–137.95.48.95) | 0.07 (0.02–0.11) |
| Male | 1,657,600 (834164–2938052) | 70.37 (35.3–125.34.3.34) | 3,021,199 (1515880–5378422) | 72.95 (36.6–129.73.6.73) | 0.1 (0.07–0.13) |
| Age | |||||
| 5–9 years | 1171 (425–2458) | 0.2 (0.07–0.42) | 1393 (535–2891) | 0.2 (0.08–0.42) | 0.05 (0.04–0.07) |
| 10–14 years | 24,391 (11141–47417) | 4.55 (2.08–8.85) | 31,268 (14206–60671) | 4.69 (2.13–9.1) | 0.13 (0.11–0.15) |
| 15–19 years | 128,685 (60966–226240) | 24.77 (11.74–43.56) | 167,635 (79397–294116) | 26.87 (12.72–47.14) | 0.21 (0.18–0.25) |
| 20–24 years | 292,361 (136213–547708) | 59.41 (27.68–111.3) | 399,168 (185509–747252) | 66.84 (31.07–125.13.07.13) | 0.29 (0.21–0.36) |
| 25–29 years | 387,427 (182583–721925) | 87.53 (41.25–163.1) | 568,087 (268736–1054453) | 96.56 (45.68–179.22.68.22) | 0.31 (0.26–0.36) |
| 30–34 years | 407,905 (194113–759298) | 105.83 (50.36–197) | 672,627 (319340–1256059) | 111.27 (52.83–207.79.83.79) | 0.25 (0.19–0.3) |
| 35–39 years | 398,894 (188082–756015) | 113.24 (53.4–214.63.4.63) | 688,644 (326947–1299573) | 122.78 (58.29–231.71.29.71) | 0.25 (0.16–0.34) |
| 40–44 years | 343,459 (162278–656231) | 119.89 (56.65–229.07.65.07) | 640,274 (302039–1220893) | 127.99 (60.38–244.06.38.06) | 0.12 (0.02–0.22) |
| 45–49 years | 286,646 (141410–555518) | 123.45 (60.9–239.25.9.25) | 591,777 (294187–1144022) | 124.98 (62.13–241.61.13.61) | −0.04 (−0.11-0.02.11.02) |
| 50–54 years | 271,380 (130513–503962) | 127.67 (61.4–237.08.4.08) | 557,571 (269041–1033264) | 125.32 (60.47–232.23.47.23) | −0.1 (−0.14–0.07) |
| 55–59 years | 251,971 (122590–472393) | 136.05 (66.19–255.07.19.07) | 528,662 (257994–988775) | 133.59 (65.19–249.86.19.86) | −0.06 (−0.12-0.12) |
| 60–64 years | 222,046 (109224–391788) | 138.25 (68.01–243.94.01.94) | 444,748 (219067–784722) | 138.96 (68.45–245.19.45.19) | −0.08 (−0.13–0.02) |
| 65–69 years | 176,300 (86861–311438) | 142.63 (70.27–251.95.27.95) | 383,357 (188619–676535) | 138.98 (68.38–245.26.38.26) | −0.1 (−0.11–0.08) |
| 70–74 years | 122,217 (60862–223222) | 144.36 (71.89–263.66.89.66) | 290,308 (144384–529598) | 141.04 (70.14–257.29.14.29) | −0.07 (−0.11–0.04) |
| 75–79 years | 87,610 (43345–148504) | 142.33 (70.42–241.25.42.25) | 182,416 (90078–312484) | 138.31 (68.3–236.94.3.94) | −0.08 (−0.12–0.04) |
| 80–84 years | 46,592 (22533–81908) | 131.71 (63.7–231.54.7.54) | 112,106 (54489–196992) | 128 (62.21–224.92.21.92) | −0.11 (−0.14–0.07) |
| 85–89 years | 17,802 (8288–33497) | 117.81 (54.85–221.67.85.67) | 51,464 (24063–96008) | 112.56 (52.63–209.98.63.98) | −0.14 (−0.17–0.11) |
| 90–94 years | 4670 (2268–8965) | 108.99 (52.93–209.2) | 18,685 (9113–36088) | 104.45 (50.94–201.73.94.73) | −0.14 (−0.16–0.13) |
| 95 + years | 1176 (569–2159) | 115.52 (55.91–212.09.91.09) | 5973 (2917–11040) | 109.6 (53.52–202.55.52.55) | −0.1 (−0.13–0.07) |
| SDI region | |||||
| Low SDI | 313,170 (158640–552443) | 93.72 (47.37–166.76.37.76) | 748,244 (378515–1323335) | 93.73 (47.36–166.86.36.86) | 0.01 (0.01–0.01) |
| Low-middle SDI | 829,855 (419541–1471666) | 95.63 (48.12–169.56.12.56) | 1,718,835 (864434–3039008) | 96.06 (48.29–169.97.29.97) | 0.01 (−0.01–0.02.01.02) |
| Middle SDI | 960,430 (486152–1705950) | 65.54 (32.98–116.41.98.41) | 1,940,951 (974678–3452927) | 71.61 (36.01–126.92.01.92) | 0.28 (0.25–0.3) |
| High-middle SDI | 697,106 (352828–1237087) | 64.6 (32.61–114.71.61.71) | 1,003,165 (503937–1782284) | 61.33 (31.01–108.81.01.81) | −0.23 (−0.31–0.16) |
| High SDI | 668,088 (336435–1193738) | 66.45 (33.49–119.01.49.01) | 919,091 (462214–1632391) | 64.36 (32.49–114.95.49.95) | −0.19 (−0.27–0.1) |
Globally, 3.47 million (95% UI: 1.75–6.13) YLDs were caused by GERD in 1990, and 6.34 million (95% UI: 3.19–11.24) YLDs were caused by GERD in 2021 (Table 4). The age-standardized YLD rate (ASYR) increased from 73.01 (95% UI: 36.75–129.66) in 1990 to 75.56 (95% UI: 38.05–133.87) in 2021 per 100,000 population with an EAPC of 0.37 (95% UI: 0.29–0.45) being observed (Table 4; Fig. 3).
Table 4.
The absolute number of YLDs cases and age-standardized YLD rate (ASYR) for gastroesophageal reflux disease in 1990 and 2019 and their temporal trends from 1990 to 2021
| 1990 | 2021 | EAPC (95% UI) | |||
|---|---|---|---|---|---|
| number (95% UI) | ASR (95% UI) | number (95% UI) | ASR (95% UI) | ||
| Global | 3,472,703 (1752693–6128627) | 73.01 (36.75–129.66.75.66) | 6,336,162 (3189794–11241353) | 75.56 (38.05–133.87.05.87) | 0.37 (0.29–0.45) |
| Sex | |||||
| Female | 1,815,102 (918529–3195138) | 75.62 (38.18–133.94.18.94) | 3,314,963 (1673914–5863205) | 78.14 (39.48–137.95.48.95) | 0.07 (0.02–0.11) |
| Male | 1,657,600 (834164–2938052) | 70.37 (35.3–125.34.3.34) | 3,021,199 (1515880–5378422) | 72.95 (36.6–129.73.6.73) | 0.1 (0.07–0.13) |
| Age | |||||
| 5–9 years | 1171 (425–2458) | 0.2 (0.07–0.42) | 1393 (535–2891) | 0.2 (0.08–0.42) | 0.05 (0.04–0.07) |
| 10–14 years | 24,391 (11141–47417) | 4.55 (2.08–8.85) | 31,268 (14206–60671) | 4.69 (2.13–9.1) | 0.13 (0.11–0.15) |
| 15–19 years | 128,685 (60966–226240) | 24.77 (11.74–43.56) | 167,635 (79397–294116) | 26.87 (12.72–47.14) | 0.21 (0.18–0.25) |
| 20–24 years | 292,361 (136213–547708) | 59.41 (27.68–111.3) | 399,168 (185509–747252) | 66.84 (31.07–125.13.07.13) | 0.29 (0.21–0.36) |
| 25–29 years | 387,427 (182583–721925) | 87.53 (41.25–163.1) | 568,087 (268736–1054453) | 96.56 (45.68–179.22.68.22) | 0.31 (0.26–0.36) |
| 30–34 years | 407,905 (194113–759298) | 105.83 (50.36–197) | 672,627 (319340–1256059) | 111.27 (52.83–207.79.83.79) | 0.25 (0.19–0.3) |
| 35–39 years | 398,894 (188082–756015) | 113.24 (53.4–214.63.4.63) | 688,644 (326947–1299573) | 122.78 (58.29–231.71.29.71) | 0.25 (0.16–0.34) |
| 40–44 years | 343,459 (162278–656231) | 119.89 (56.65–229.07.65.07) | 640,274 (302039–1220893) | 127.99 (60.38–244.06.38.06) | 0.12 (0.02–0.22) |
| 45–49 years | 286,646 (141410–555518) | 123.45 (60.9–239.25.9.25) | 591,777 (294187–1144022) | 124.98 (62.13–241.61.13.61) | −0.04 (−0.11-0.02.11.02) |
| 50–54 years | 271,380 (130513–503962) | 127.67 (61.4–237.08.4.08) | 557,571 (269041–1033264) | 125.32 (60.47–232.23.47.23) | −0.1 (−0.14–0.07) |
| 55–59 years | 251,971 (122590–472393) | 136.05 (66.19–255.07.19.07) | 528,662 (257994–988775) | 133.59 (65.19–249.86.19.86) | −0.06 (−0.12-0.12) |
| 60–64 years | 222,046 (109224–391788) | 138.25 (68.01–243.94.01.94) | 444,748 (219067–784722) | 138.96 (68.45–245.19.45.19) | −0.08 (−0.13–0.02) |
| 65–69 years | 176,300 (86861–311438) | 142.63 (70.27–251.95.27.95) | 383,357 (188619–676535) | 138.98 (68.38–245.26.38.26) | −0.1 (−0.11–0.08) |
| 70–74 years | 122,217 (60862–223222) | 144.36 (71.89–263.66.89.66) | 290,308 (144384–529598) | 141.04 (70.14–257.29.14.29) | −0.07 (−0.11–0.04) |
| 75–79 years | 87,610 (43345–148504) | 142.33 (70.42–241.25.42.25) | 182,416 (90078–312484) | 138.31 (68.3–236.94.3.94) | −0.08 (−0.12–0.04) |
| 80–84 years | 46,592 (22533–81908) | 131.71 (63.7–231.54.7.54) | 112,106 (54489–196992) | 128 (62.21–224.92.21.92) | −0.11 (−0.14–0.07) |
| 85–89 years | 17,802 (8288–33497) | 117.81 (54.85–221.67.85.67) | 51,464 (24063–96008) | 112.56 (52.63–209.98.63.98) | −0.14 (−0.17–0.11) |
| 90–94 years | 4670 (2268–8965) | 108.99 (52.93–209.2) | 18,685 (9113–36088) | 104.45 (50.94–201.73.94.73) | −0.14 (−0.16–0.13) |
| 95 + years | 1176 (569–2159) | 115.52 (55.91–212.09.91.09) | 5973 (2917–11040) | 109.6 (53.52–202.55.52.55) | −0.1 (−0.13–0.07) |
| SDI region | |||||
| Low SDI | 313,170 (158640–552443) | 93.72 (47.37–166.76.37.76) | 748,244 (378515–1323335) | 93.73 (47.36–166.86.36.86) | 0.01 (0.01–0.01) |
| Low-middle SDI | 829,855 (419541–1471666) | 95.63 (48.12–169.56.12.56) | 1,718,835 (864434–3039008) | 96.06 (48.29–169.97.29.97) | 0.01 (−0.01–0.02.01.02) |
| Middle SDI | 960,430 (486152–1705950) | 65.54 (32.98–116.41.98.41) | 1,940,951 (974678–3452927) | 71.61 (36.01–126.92.01.92) | 0.28 (0.25–0.3) |
| High-middle SDI | 697,106 (352828–1237087) | 64.6 (32.61–114.71.61.71) | 1,003,165 (503937–1782284) | 61.33 (31.01–108.81.01.81) | −0.23 (−0.31–0.16) |
| High SDI | 668,088 (336435–1193738) | 66.45 (33.49–119.01.49.01) | 919,091 (462214–1632391) | 64.36 (32.49–114.95.49.95) | −0.19 (−0.27–0.1) |
Sex-specific burden in GERD
In terms of GERD, the numbers of prevalent, incident, DALY, and YLD cases, as well as the ASPR, ASIR, ASDR and ASYR for females, were higher than those for males at the global level in 2021 (Figure S1).
From 1990 to 2021, the ASPR for females increased from 9898.36 (95% UI: 8782.84–11093.73) per 100,000 population in 1990 to 10229.08 (95% UI: 9084.3–11502.23) per 100,000 population in 2021, with an EAPC of 0.06 (95% UI: 0.02–0.11). In contrast, the ASPR for males increased from 9130.43 (95% UI: 8056.67–10231.29) in 1990 to 9442.63 (95% UI: 8333.56–10619.85.56.85) per 100,000 population in 2021, with an EAPC of 0.09 (95% UI: 0.06–0.12) (Table 1).
Additionally, the ASIR for females increased from 3879.78 (95% UI: 3433.47–4308.62) in 1990 to 4025.55 (95% UI: 3563.96–4461.25) in 2021 per 100,000 population, with an EAPC of 0.09 (95% UI: 0.05–0.12). The ASIR for males increased from 3599.47 (95% UI: 3178.62–3991.88) in 1990 to 3737.01 (95% UI: 3318.13–4153.78) in 2021 per 100,000 population, with an EAPC of 0.11 (95% UI: 0.08–0.14) (Table 2).
Trends in the numbers of prevalent, incident, DALY, and YLD cases, as well as the ASPR, ASIR, ASDR and ASYR, of GERD by sex from 1990 to 2021 are depicted in Figure S2.
Age-specific burden in patients with GERD
In 2021, the ASPR, ASIR, ASDR and ASYR of GERD increased with age and peaked in the 70–74-year-old group [ASPR: 19188.81 (95% UI: 14512.07–24138.81), ASIR: 6950.69 (95% UI: 4899.54–8964.53), ASDR: 141.04 (95% UI: 70.14–257.29), and ASYR: 141.04 (95% UI: 70.14–257.29)] (Figure S3). Moreover, the numbers of prevalent, incident, DALY and YLD cases of GERD first increased but subsequently decreased with age, with the highest values observed in the 35–39 years age group in 2021 (Figure S3).
From 1990 to 2021, the fastest increase in the ASPR of GERD occurred in the 25–29 year age group (EAPC = 0.30, 95% UI: 0.25–0.35) (Table 1). Additionally, the fastest increase in the ASIR occurred in the same age group (EAPC = 0.32, 95% UI: 0.27–0.36) (Table 2). Trends in the numbers of prevalent, incident, DALY, and YLD cases, as well as the ASPR, ASIR, ASDR and ASYR of GERD by age from 1990 to 2021, are depicted in Figure S4.
Regional and National burden of GERD
In 2021, the highest ASPR of GERD occurred in the low-middle-SDI region [12563.56 (95% UI: 11184.77–14064.75)], with the highest ASIR occurring in the same region [4894.02 (95% UI: 4362.32–5416.81)] (Figure S5). The numbers of prevalent, incident, DALY, and YLD cases of GERD by SDI region in 2021 are depicted in Figure S5.
From 1990 to 2021, the fastest increase in the ASPR of GERD occurred in the middle-SDI region, with an EAPC of 0.27 (95% UI: 0.24–0.3) (Table 1). The fastest growth in ASIR occurred in the same region, with an EAPC of 0.28 (95% UI: 0.26–0.31) (Table 2). Conversely, the ASPR and ASIR in the high-middle-SDI region decreased at the fastest rate [ASPR: −0.25 (95% UI: −0.32–0.17) and ASIR: −0.23 (95% UI: −0.3–0.15)]. Trends in the numbers of prevalent, incident, DALY and YLD cases of GERD by SDI region from 1990 to 2021 are depicted in Figure S6.
In 2021, the three countries with the highest ASPRs of GERD were Paraguay [16774.68 (95% UI: 14835.88–18709.59)], Brazil [16678.1 (95% UI: 14840.12–18432.84)] and El Salvador [16451.67 (95% UI: 14553.58–18347.53)]. Moreover, the highest ASIRs of GERD occurred in Brazil [6249.93 (95% UI: 5569.09–6875.72)], Mexico [6219.29 (95% UI: 5559.67–6822.16)] and Paraguay [6177.95 (95% UI: 5528.53–6806.6)] (Fig. 2). A global map of the numbers of prevalent, incident, DALY and YLD cases of GERD in 2021 is depicted in Figure S7.
From 1990 to 2021, the fastest increase in the ASPR of GERD occurred in Israel (EAPC = 1.00; 95% UI: 0.68–1.33), Mali (EAPC = 0.97; 95% UI: 0.61–1.34) and Guinea-Bissau (EAPC = 0.79; 95% UI: 0.53–1.04). Additionally, the fastest growth in ASIR occurred in Cabo Verde (EAPC = 0.89; 95% UI: 0.56–1.22), Israel (EAPC = 0.84; 95% UI: 0.55–1.13) and Burkina Faso (EAPC = 0.71; 95% UI: 0.48–0.93) (Fig. 3).
Projection to 2050
As projected by the ARIMA model, between 2022 and 2050, the numbers of prevalent, incident, DALY and YLD cases for GERD are projected to increase annually for both males and females. Globally, the number of prevalent cases is projected to increase by 48.2%, from 825.60 million in 2021 to 1,223.87 million in 2050. This estimated growth is driven by increases in both sexes, although a greater relative increase is projected for females (50.9% increase, from 434.75 to 656.14 million) than for males (43.7% increase, from 390.85 to 561.73 million).
Additionally, by 2050, the number of incident cases of GERD is expected to be 252.30 million (95% UI: 220.07–284.53) in females and 218.95 million (95% UI: 183.01–254.89) in males. The ASPR, ASIR, ASDR and ASYR of GERD are anticipated to increase linearly for both females and males from 2022 to 2050 (Fig. 4).
Fig. 4.
Projections for predicting the global burden of gastroesophageal reflux disease in 2050, which were performed using the autoregressive integrated moving average (ARIMA) Model
As projected by the ES model, between 2022 and 2050, the numbers of prevalent, incident, DALY and YLD cases for GERD are projected to increase annually for both females and males. However, unlike the predictions of the ARIMA model, the growth rates of ASPR, ASIR, ASDR and ASYR are expected to remain stable for both females and males (Fig. 5).
Fig. 5.
Projections for predicting 2050 of the global burden of gastroesophageal reflux disease in 2050, which were performed using the exponential smoothing (ES) model
Discussion
Global burden of GERD
GERD is becoming an increasingly significant global public health concern. Our analysis of the global burden of GERD from 1990 to 2021 revealed a steady increase in its prevalence, incidence, DALYs, and YLDs. The burden was consistently higher among females and exhibited a distinct age-related pattern, with the highest age-standardized rates in the elderly (70–74 years) but the greatest absolute number of cases in middle-aged adults (35–39 years). Geographically, the low-middle-SDI region experienced the highest burden in 2021, while the middle-SDI region experienced the most rapid growth over the study period. Projections to 2050 indicate that this upwards trajectory is expected to continue, with the number of prevalent cases surpassing 1.2 billion globally. These findings emphasize the urgent need for targeted interventions and improved health care strategies to curb the growing impact of GERD worldwide.
Our results are consistent with those of the GBD 2019 Study, which reported a global incidence of GERD of 783.95 million cases in 2019 [8]. However, our updated estimates for 2021 (825.60 million cases) reveal a continued upwards trajectory (EAPC = 0.37), thus suggesting that the burden of GERD is increasing at a faster rate than previously projected. This accelerated rate may reflect the compounding effects of increasing obesity rates and ageing populations, particularly in middle-SDI regions, where the fastest increase in the GERD burden has occurred (EAPC = 0.27).
Sex-specific burden of GERD
The global burden of GERD remains higher in females than in males, likely because of sex-related differences in biological factors (e.g., hormonal influences on esophageal sphincter function [24, 25] and obesity patterns [26]). However, the rate of increase has been faster among males, a trend potentially driven by steeper increases in modifiable risk factors, such as central obesity, consumption of processed foods, smoking, and alcohol use [27, 28], as well as historically lower health care-seeking behaviour that may have led to underdiagnosis in earlier years [29]. Improved awareness and health care access in recent decades may now amplify the detected incidence in men. These findings highlight the need for sex-specific public health strategies. Tailored interventions for women should address underlying biological susceptibility, whereas those for men should focus on reducing behavioural risk and encouraging early care seeking.
Age-related patterns in GERD burden
The age-specific burden of GERD exhibits a distinct pattern, with age-standardized rates (ASPR, ASIR, ASDR, and ASYR) peaking in the 70–74 age group in 2021. This reflects age-related physiological decline and higher rates of comorbidities [30, 31]. Long-term exposure to risk factors such as obesity, specific dietary patterns, and medications also contributes to increased disease burden among older adults [24]. Notably, the highest absolute case numbers occur in the 35–39 age group, likely because of better health care access and diagnosis in middle-aged populations [29]. Of particular concern is the rapid increase observed among the 25–29-year age cohort, indicating an epidemiological shift driven by unhealthy lifestyles and rising obesity rates [24]. These trends highlight the need for age-specific management strategies. For older adults, effective symptom control through both pharmacological and nonpharmacological approaches is essential. For younger people, early preventive measures focusing on lifestyle and dietary changes are critical for reducing the future burden of GERD.
Regional variations in GERD burden
Although the GBD 2019 reported the highest prevalence of GERD in high-income regions, our 2021 findings indicate a shift, with the low-middle-SDI region now showing the highest age-standardized prevalence rate [14, 15, 27]. This transition underscores an epidemiological change associated with urbanization and dietary shifts in LMICs. The fastest increase in GERD burden from 1990 to 2021 occurred in middle-SDI regions [15], likely due to lifestyle changes and rising obesity, whereas high- to middle-SDI regions experienced the most rapid decline, reflecting better health care access and management [14]. At the national level, Paraguay, Brazil, and El Salvador had the highest prevalence rates in 2021, whereas Brazil and Mexico reported the highest incidence [14, 24]. Notable increases in ASPR occurred in Israel and Mali, highlighting diverse epidemiological trends. High-burden countries typically exhibit diets rich in fat and low in fibre, alongside elevated obesity rates that exacerbate reflux risk. Differences in health care infrastructure and diagnostic coding practices may also contribute to cross-national variations in reported GERD rates.
Future projections and risk factors
Using the ARIMA and ES models, our study revealed a continuous increase in GERD cases through 2050, with the prevalence expected to reach 656.14 million cases among females and 561.73 million cases among males. These findings underscore the need for comprehensive global health strategies for GERD prevention, early diagnosis, and management. The increasing burden of GERD is driven by factors such as obesity, dietary patterns, smoking, and lifestyle changes [27–32]. Key management strategies include lifestyle modifications such as weight reduction and dietary adjustments, as well as the cautious use of pharmacological therapies such as PPIs to balance efficacy with potential adverse effects [33–36]. Moreover, the implementation of public health initiatives to increase awareness, promote early intervention, and encourage healthier lifestyles is crucial for curbing the growing burden of GERD [37–40]. Recent studies support our findings regarding the effects of diet and obesity on GERD and highlight the need for balanced management strategies [13, 16, 17].
Study limitations and future research directions
This study had several limitations that should be acknowledged. First, the use of ICD codes to identify GERD cases had inherent limitations. Specifically, the coding accuracy may vary across regions, which may have led to the underestimation or overestimation of GERD cases. Additionally, symptom-based coding (such as R12) may be ambiguous because heartburn may be associated with other diseases. Second, the reliance on modelled GBD data introduces potential biases, particularly in regions with limited epidemiological surveillance. Future research should prioritize the refinement of GERD burden estimates through population-based cohort studies that integrate endoscopic and histopathological assessments. Finally, although we used the most comprehensive GBD 2021 data available at the time of analysis, the upcoming GBD 2023 estimates may provide updated insights into the global burden of GERD.
Future studies should integrate these updated data to increase the accuracy of trend analyses and predictions. Additionally, the exploration of genetic and microbiome-related determinants of GERD susceptibility could provide new insights into personalized treatment strategies. Longitudinal studies are needed to evaluate the long-term efficacy of GERD treatment and its complications, including cost-effectiveness analyses of preventive interventions, which are essential for guiding evidence-based health policy decisions.
Conclusions
The global burden of GERD has significantly increased over the past three decades, with pronounced disparities observed across regions, sexes, and age groups. Low- to middle-SDI regions continue to report the highest prevalence of GERD, whereas middle-SDI regions exhibit the most rapid increase. The projected increase in the GERD burden through 2050 highlights the urgent need for comprehensive prevention and management strategies. Strengthening the health care infrastructure, increasing public awareness, and promoting effective lifestyle interventions will be essential for mitigating the future burden of GERD and its associated complications. Moreover, international collaboration and sustained research efforts will be crucial in addressing the complex epidemiology of GERD and optimizing global disease management.
Supplementary Information
Acknowledgements
We thank Dr.Ninel Azoitei from Ulm University for his linguistic assistance during the preparation of this manuscript.
Abbreviations
- GERD
Gastroesophageal reflux disease.
- LMICs
Low- and middle-income countries.
- GBD
Global Burden of Disease.
- PPIs
Proton pump inhibitors.
- SDI
Sociodemographic index.
- UI
Uncertainty intervals.
- ICD-10
International Classification of Diseases.
- DALYs
Disability-adjusted life years.
- YLDs
Years lived with disability.
- ASR
Age-standardized rate.
- EAPC
Estimated annual percentage change.
- ARIMA
Autoregressive integrated moving average.
- ES
Exponential smoothing.
- ASDR
Age-standardized disability-adjusted life-years rate.
- ASPR
Age-standardized prevalence rate.
- ASIR
Age-standardized incidence rate.
- ASYR
Age-standardized years lived with disability rate.
Authors’ contributions
Conception and design: Lu Chen, Yang Liu and Ruihua Shi; data acquisition: Xiaoxia Yang and Mingyue Hu; data analysis and interpretation: Yuan Ding and Lixia Zhou; manuscript drafting: Lu Chen; manuscript revision: Zhi Wang; and guidance and funding support: Ruihua Shi.
Funding
This study was funded by the grants from Zhongda Hospital Affiliated to Southeast University, Jiangsu Province High-Level Hospital Construction Funds (No. YKK24268) and the Nanjing Science and Technology Development Program (No. 202305041).
Data availability
The data that were used and analysed in this study are available from the lead author and the corresponding authors upon reasonable request.
Declarations
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Zhi Wang, Email: 76wangzhi176@163.com.
Yang Liu, Email: ly43101240@163.com.
Ruihua Shi, Email: ruhuashi@126.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that were used and analysed in this study are available from the lead author and the corresponding authors upon reasonable request.