COMPARISON OF THE PREVALENCES OF AND FACTORS ASSOCIATED WITH GASTROESOPHAGEAL REFLUX DISEASE IN RURAL AND URBAN BALI, INDONESIA

Abstract

The prevalences of and factors associated with gastroesophageal reflux disease (GERD) in urban and rural areas of Bali, Indonesia have not been published.  In this cross-sectional study, we aimed to compare the prevalences of and factors associated with GERD in urban and rural Bali, Indonesia, in order to better inform efforts to manage these conditions by location.  Urban study subjects were recruited consecutively from those having a medical checkup at either one of 2 referral hospitals in Denpasar City, Bali and rural study subjects were recruited consecutively from those presenting to the health center in Kintamani District, Bali during the study period.  The minimum numbers of study subjects calculated to be needed from rural and urban areas were: 150 and 200 subjects, respectively.  Inclusion criteria for study subjects were being aged ≥18 years and being healthy.  Exclusion criteria for study subjects were being aged <18 years, regularly using a proton pump inhibitor or H-2 blocker or having a history of gastrointestinal disease.  Each subject was asked to complete a questionnaire asking about demographics, symptoms of GERD, nutritional status, smoking history, alcohol, coffee intake, non-steroidal anti-inflammatory drug (NSAID) or steroid use and meat and/or fatty food consumption.  The study was conducted during July-December 2019.  A total of 400 subjects were included in the study; 58.5% (n=234) females: 250 urban subjects, 64.4% (n=161) females, and 150 rural subjects, 51.3% (n=77) males.  The overall prevalence of GERD among study subjects was 21.3% (n=85): 27.3% rural subjects and 17.6% urban subjects (p=0.021).  Among subjects with GERD, 87.8% of rural subjects and 34.1% of urban subjects (p<0.001) had low education levels (≤12 years education).  Smoking was significantly (p=0.046) more common among rural subjects with GERD (31.7%) than urban subjects with GERD (13.6%).  NSAID use was significantly (p=0.012) more common among rural subjects (34.1%) than urban subjects with GERD (11.4%).  Frequent consumption of fatty foods was significantly (p=0.006) more common among urban subjects (88.6%) than rural subjects with GERD (63.4%).  In summary, the prevalence of GERD in Bali was significantly more common among rural than urban subjects.  Rural subjects with GERD were significantly more likely to have a low education level, to smoke and to use NSAIDs while urban subjects with GERD were significantly more like to consume fatty foods.  We conclude these factors need to be evaluated further to determine if they are merely associated with or if they cause GERD and if changing them can prevent GERD.