{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:10:07Z","timestamp":1787317807334,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DK135449"],"award-info":[{"award-number":["T32DK135449"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Symptoms and reflux burden in gastroesophageal reflux disease (\n GERD<\/jats:styled-content>\n ) may vary between populations.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To evaluate relationships between symptom profiles and objective reflux burden in patients in two world regions, Asia and the United States.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a cross\u2010sectional study of patients undergoing\n pH<\/jats:styled-content>\n \u2010impedance monitoring from one Asian and two\n US<\/jats:styled-content>\n centres. Validated patient\u2010reported symptom instruments were prospectively collected. Symptom characteristics were compared against objective reflux burden (acid exposure time,\n AET<\/jats:styled-content>\n ; total reflux episodes,\n TRE<\/jats:styled-content>\n ; mean nocturnal baseline impedance,\n MNBI<\/jats:styled-content>\n ) from\n pH<\/jats:styled-content>\n \u2010impedance monitoring between the two populations.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 1099 patients, 162 were in Asia (age 47.4\u2009\u00b1\u20091.1\u2009years, 36.4% female, body mass index, BMI 24.2\u2009\u00b1\u20090.4\u2009kg\/m\n 2<\/jats:sup>\n ) and 937 in the United States (53.1\u2009\u00b1\u20091.3\u2009years, 67.7% female, BMI 30.1\u2009\u00b1\u20090.3\u2009kg\/m\n 2<\/jats:sup>\n ). Regurgitation dominated in Asia (59.9% vs. 50.3% heartburn in the United States), with higher TRE (55.4\u2009\u00b1\u20092.4 vs. 46.4\u2009\u00b1\u20091.2,\n p<\/jats:italic>\n \u2009<\u20090.001). Despite this, reflux burden was lower in Asia (mean AET 2.19%\u2009\u00b1\u20090.4% vs. 3.53%\u2009\u00b1\u20090.2%; pathologic AET 11.1% vs. 20.5%; MNBI 2472\u2009\u00b1\u200962\u2009\u03a9 vs. 1745\u2009\u00b1\u200981\u2009\u03a9; conclusive GERD per Lyon 2.0: 13% vs. 25.7%) (all\n p<\/jats:italic>\n \u2009<\u20090.001), with higher symptom burden (GERDQ 8.97\u2009\u00b1\u20090.2 vs. 8.44\u2009\u00b1\u20090.1,\n p<\/jats:italic>\n \u2009<\u20090.05; global symptom severity, GSS: 65.1\u2009\u00b1\u20091.8 vs. 48.1\u2009\u00b1\u20091.1,\n p<\/jats:italic>\n \u2009=\u20090.001). Changing the AET threshold to 4% increased diagnostic yield by 21% among Asians (\n p<\/jats:italic>\n \u2009=\u20090.035 vs. US). On multivariable linear regression, Asian patients (\u03b2\u2009=\u200919.3,\n p<\/jats:italic>\n \u2009<\u20090.0001), higher AET (\u03b2\u2009=\u20091.02,\n p<\/jats:italic>\n \u2009=\u20090.0004), higher reflux episodes (\u03b2\u2009=\u20090.11,\n p<\/jats:italic>\n \u2009=\u20090.0029), lower BMI (\u03b2\u2009=\u2009\u22120.37,\n p<\/jats:italic>\n \u2009=\u20090.0046) and female sex (\u03b2\u2009=\u20098.14,\n p<\/jats:italic>\n \u2009=\u20090.0007) were independent predictors for higher GSS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Compared to US patients, GERD profiles in Asian patients associate with higher symptom reporting despite lower objective reflux burden.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/apt.70713","type":"journal-article","created":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T14:48:36Z","timestamp":1778424516000},"page":"471-478","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Asian Patients Report Higher Reflux Symptom Burden than US Patients Despite Lower Objective Reflux Burden"],"prefix":"10.1111","volume":"64","author":[{"given":"Walter W.","family":"Chan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Wun","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew K.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyson G.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9084-8210","authenticated-orcid":false,"given":"Chien\u2010Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Prakash","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-023-00883-z"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2012-304269"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-313589"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003482"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.01.025"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm21077"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330616"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322627"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04142.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(02)00097-8"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003499"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000002352"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.11.035"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-321395"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1215291"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-016-1282-1"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13702"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.08.024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.08.019"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14986"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003083"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12946"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e32835f594c"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01576.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12135"}],"container-title":["Alimentary Pharmacology & Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70713","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.70713","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.70713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:34:16Z","timestamp":1785461656000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.70713"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,10]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/apt.70713"],"URL":"https:\/\/doi.org\/10.1111\/apt.70713","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,10]]},"assertion":[{"value":"2026-03-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}