Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Bulgaria: an internet-based survey

Background: The global pooled prevalence of gastroesophageal reflux disease (GORD) is approximately 14% and varies significantly according to the country. More population-based studies are needed in regions lacking epidemiological data on the prevalence of GORD, such as Eastern Europe, particularly Bulgaria. This current study aimed to evaluate the prevalence of GORD in Bulgaria and assess the risk factors associated with this disorder.Methods: An internet-based health survey was sent to Bulgarian adults. Individuals were invited to complete an online questionnaire on general and gastrointestinal (GI) health. The aim of the study was not explicitly stated. The survey collected data on socio-demographic and behavioral characteristics, validated questions to assess GORD, diagnostic questions based on Rome IV criteria to assess irritable bowel syndrome (IBS) and functional dyspepsia (FD), and questions about antisecretory drugs usage.Results: Data was collected from 1896 individuals (mean age = 35.5 years, SD = 11.7, 73.1% females). The prevalence of GORD in the study population was 27.5%, while 57.29% of all GORD patients taking PPIs had PPI-refractory GORD. Age (p=0.02), BMI (p<0.001), marital status (p=0.03), occupation (p<0.001), sexual problems (p<0.001), FD (p<0.001), and IBS (p<0.001) were significantly associated with GORD prevalence. Patients with FD (p<0.001; OR 5.38), IBS (p=0.03; OR 1.07), and with higher BMI (p<0.001, OR 1.05) were at an increased risk of having GORD.Conclusions: The first data on GORD prevalence in the adult population in Bulgaria has been reported. Disorders of gut-brain interaction have a significant impact on the prevalence of GORD.