Looking back at GERD prevalence in existing literature, global prevalence in a systematic review and meta-analysis stood at 13.98%{17}. Diving more locally in the region, a study performed in Saudia Arabia showed a much higher prevalence of 28.7% {16}, while a study performed here in Syria at Damascus University, has shown a significantly low GERD prevalence of 8.6%. Finally, the results of this study on Syrian students and staff concluded GERD prevalence at 18.3%. Given the large population size, this number can be used to estimate GERD prevalence in Syria as a whole. The GERD prevalence in this study is almost double that estimated by the other research at Damascus University. This significant difference could be attributed to several factors, most important of which is this study having a much larger population with a wider variety of age groups, social and economical backgrounds, as well as not including other GI diseases overlap.
To dive into the attributes involved in this study and how they compare to existing research, all the factors must be studied. For the purposes of this study, the statistical significance of a factor and its positive correlation with GERD would be concluded if the factor showed a P-value lower than 0.05.
Firstly, this study concluded that a patient’s gender could be a factor, as an AOR of 1.691 with a 95% Confidence Interval (CI) at 1.187–2.409. Existing literature debates on whether being attributed to a specific gender puts a patient at a higher risk of developing GERD. Studies have shown that there is a higher chance of men developing erosive esophagitis {18}. No upper GI was performed in this study to be able to derive a reasonable comparison. Literature has shown that the elderly have a higher tendency of developing GERD.
This study has shown that participants aged 40 and above have shown higher GERD prevalence. Notwithstanding the P-value was low. This could be attributed to the low percentage of participants that fall into that age range {27,28,1,2}.
As for socio-economic factors, divorcees in this research have shown an AOR of 2.065 (95% CI 0.655–6.514) and widows an AOR of 2.439 (95% CI 0.481–12.366). This however doesn’t correspond with the findings of other studies, wherein it was noticed that married individuals experienced a higher prevalence of GERD {27, 29}.
Furthermore, this study has shown that, the worse the economic status of an individual, the higher their likelihood (AOR) of developing GERD was. It is important to note that the literature about the economic factor is very limited, making it harder to conclude that low economic status is a contributing factor to heightened GERD prevalence{30], however previous factors have low P-value.
This research has also shown that eating and other social habits such as caffeine intake, smoking or alcohol consumption are contributing factors to GERD prevalence.
When it comes to eating habits, this study has shown that consuming only one meal per day had a significant AOR of 2.042 (95% CI 1.109–3.762).
Furthermore, an increasing number of meals consumed per day had a negative correlation with GERD prevalence with a P-value of 0.022. As for consuming more than 3 meals per day seemed to have the least GERD prevalence, however there was no statistical significance as the P-value was above 0.05. A previous study supports this conclusion, as it has shown that females consuming a lower number of meals per day has resulted in an increased GERD prevalence, but there was no relation noticed in males{20}.
Focusing on fast food intake in particular, this study shows that a higher frequency of fast-food consumption would result in a higher likelihood of GERD. This corresponds with other present literature, as several studies on GERD and eating habits concluded that there is a higher chance of GERD prevalence with an elevated consumption of greasy and fried food {5,21}.
The time at which food is consumed also has a potential positive effect on GERD prevalence, as this study has shown that individuals eating right before sleeping showed an AOR of 1.184 (95% CI 0.699–2.007). Another study has shown that eating within 3 hours of sleeping has a positive effect on GERD prevalence {11}.
As for other consumables, smoking showed an AOR of 1.644 (95% CI 1.188–2.274). This positive correlation between smoking and GERD prevalence was also shown in other studies {19,1}. Caffeine intake stood at a strong AOR of 2.481 (95% CI 0.998–6.164). Literature has shown that an increased consumption of coffee/tea has a positive correlation with GERD prevalence {21,1}. Literature has shown that alcohol consumption has a positive effect on GERD prevalence {8,27}. However, the results of this study indicate a lower incidence. This could be attributed to the low intake in society, as well as it being a cultural taboo.
Additionally, it is well known based on literature that individuals experiencing obesity or being overweight are much more likely to develop GERD {1,2,11,15,27}. However, only a small fraction of the population used for this paper falls into that category, which made it difficult to draw any significant conclusions on the effects of a high BMI on GERD prevalence.
Another attribute that was assessed in this study was stress level, as well as strenuous exercise. An individual being under stress most of the time had an AOR of 2.443 (95% CI 1.288–4.631) a study concerning psychological factors revealed that chronic stress was also noticed to result in higher GERD prevalence [22,1}. Medium activity stood at an AOR of 1.420 (95% CI 1.021–1.976). Other studies have shown that performing strenuous exercise results in a higher prevalence of GERD {23,1]. However, that disagreement could be attributed to this study having a smaller population with a low percentage of that population performing strenuous exercise, hence leading to a possible bias in the results.
On the medical side, this study has shown that medication use can indeed help induce or accelerate GERD as it shows an AOR of 1.573 (95% CI 1.143–2.166). Studies performed in Poland and across the world have shown that drug use can have an aggravating effect on GERD {23,1}.
As for medical conditions, literature has shown that Hiatal Hernia in specific influences GERD prevalence since it is a GERD mechanism. The results of this study agree with that, as untreated Hiatal Hernia has shown a very strong AOR of 10.968% (95% CI 3.579–33.611) and treated hiatal hernia with a significant AOR of 5.268 (95% CI 1.511–18.368). Studies have shown that 80% of Hiatal Hernia patients suffer from GERD {25,26}. Literature has shown that Diabetes Mellitus (DM) is a disease with a positive correlation with GERD. This study shows that DM has an AOR of 1.776 (95% CI 0.404–2.428). However, only 11 participants were diabetic and hence the P-value was high, meaning a direct relationship cannot be attributed. Other studies, however, have shown that diabetes in general, and particularly Type 2 diabetes, has an effect on GERD {5,31}. As for Hypertension (HTN), the results have shown a borderline negative correlation with GERD prevalence, as the AOR was 0.991 (95% CI 0.404–2.248). However, other studies have shown that HTN has a positive correlation with GERD and its silent symptoms {6,32}.