The global, regional, and national burden of gastroesophageal reflux disease in 204 countries and territories, 1990–2021: a retrospective cohort study

Introduction: Gastroesophageal reflux disease (GERD) is a common condition involving recurrent reflux of stomach contents, causing symptoms and complications that impact quality of life. This study aimed to assess the global GERD burden from 1990 to 2021. Methods: We used the Global Burden of Disease 2021 data to analyze the incidence, prevalence, and years lived with disability (YLDs) for GERD across 204 countries. We estimated the population-level distributions by age and sex, using age-standardized incidence rate (ASIR) and age-standardized YLDs (ASYLDs). The average annual percent change (AAPC) in incidence, prevalence, and YLDs was calculated along with 95% uncertainty intervals (UIs). Results: In 2021, the global ASIR of GERD was 3881.86 per 100 000, reflecting an AAPC increase of 3.80% since 1990. The prevalence also increased, with an AAPC of 3.38%, reaching 9838.60 per 100 000. Global ASYLDs rose to 75.56 per 100 000, showing an AAPC increase of 3.49%. GERD burden varied by region; high-income areas like North America and East Asia saw declines, while Western Sub-Saharan Africa and Central Europe showed increases. India and China had the highest recorded incidences, with 36 567 410 and 20 863 747, respectively. Decomposition analyses revealed that population growth and aging contributed most to the increase in YLDs. Conclusion: The global GERD burden significantly increased from 1990 to 2021, especially in low and middle-income regions. This highlights the urgent need for enhanced public health measures, early diagnosis, and improved healthcare access to manage the growing disease burden and improve patient outcomes.