In the Western world, esophageal reflux is a common condition. In other parts of the world, the prevalence is less well defined, but appears to be swiftly approaching the levels seen in the West. As complications of this condition such as Barrett’s epithelium and esophageal adenocarcinoma have seen huge increases over the past several decades in the West, there seems a likelihood that the rest of the world is at risk for a similar explosion in esophageal complications. This article will review the epidemiologic information about esophageal reflux, and pathophysiologic components of acid migration and altered peristaltic motility, and examine the advantages of treating this growing medical illness with acid suppression and prokinetic medication, as well as other nonpharmacologic therapies. EPIDEMIOLOGY The prevalence and incidence of esophageal reflux are difficult to establish. These values are dependent on the population under study. Reported frequencies tend to be lower if the studied population is based on the general population as opposed to a study of patients from a medical facility. Frequencies based upon endoscopic observation tend to be substantially lower than symptom surveys, which is consistent with the observation that endoscopic evidence of damage is present in only 10% of symptomatic patients. Despite the differences in methods for collecting prevalence and incidence data, there appears to be variability in frequencies of reflux around the world (Table 1). In a 1997 U.S. report, the prevalence of weekly heartburn symptoms in the general population was 19. 8% (95% confidence interval 17.7-21.9) [1] . This appears to be higher than the often quoted weekly heartburn rate of 14% from 1976 [2] , suggesting an increase in reflux over the past two decades. Reflux was reported to be rare in Nigeria fifteen years ago [3] , and the low frequency was postulated to be due to protective differences in the structure of the lower esophageal sphincter. The frequency of symptoms in Taiwan recently was thought to be similar to the U.S. frequency reported two decades ago [4] , and the authors expressed concern that westernization of the diet, aging of the population, and increasing obesity would put the Taiwanese at higher risk of reflux and its sequelae. Table 1 Prevalence of reflux in various geographic sites(%)
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