Insight into global burden of gastroesophageal reflux disease: Understanding its reach and impact

Table 6 Factors associated with gastroesophageal reflux disease symptoms

Factor	Evidence
Age	With increasing age, the elasticity of the pharyngoesophageal membrane reduces, progressively leading to hiatal hernias, predisposing to GERD[128]; the prevalence of GERD symptoms is highest in those aged 40 to 59 years in the systematic review by Nirwan et al[34]
Gender	Females had a slightly higher prevalence of GERD than males in systematic reviews by Nirwan et al[34] and Friedland et al[128]
Education level	Those with the lowest education level had the highest GERD prevalence, whilst those with the highest level of education had the lowest GERD prevalence[34,129]
Ethnicities	Ethnicities can play a role in development of GERD even in the same country[14], though some studies did not find any significant difference[59]
Economic strata	Lower-income groups are reported to have a significantly higher prevalence of GERD[34,128]
Urban or rural	GERD is reported to be higher in urban populations[34,74,130]
Obesity	Obesity is an identified risk factor for GERD[34,131,132]
Mental stress	Mental stress is shown to increase GERD symptoms[9,133]
Diet	Common food items associated with GERD are: Spices[10], carbonated beverages[134], wheat products[135], tea[136], coffee[137], sour and acidic food[138], alcohol[78], chocolate[139], dietary sugar[140]
Habits	Habits associated with GERD include: Large meals[141], sleeping after eating a meal[142], eating a meal fast[135], habit of midnight snacks[143], skipping meals[143], inadequate sleep[134], exercise[142,144], smoking[145]
Diseases and treatments	Some diseases such as asthma[146], diabetes mellitus[147], and different medications[148-151] are known to be associated with GERD symptoms

GERD: Gastroesophageal reflux disease.