Academic Journal
Persistent heartburn in a multiethnic population: treatment gaps, ethnic disparities, and diagnostic yield from a large cohort.
| Title: | Persistent heartburn in a multiethnic population: treatment gaps, ethnic disparities, and diagnostic yield from a large cohort. |
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| Authors: | Abu Baker F; Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center.; Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa., Hazzan R; Liver Clinic, Clalit Health Services, Nof Haglil.; Azrieli Faculty of Medicine, Bar-Ilan University, Safed., Tatour M; Azrieli Faculty of Medicine, Bar-Ilan University, Safed.; Department of Family Medicine, Clalit Health Services, Afula., Gal O; Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center., Khader M; Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center., Natour R; Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center., Nicola D; Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center., Mansour A; Gastroenterology Unit., Abboud W; Department of Surgery, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel., Hany S; Department of Surgery, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel., Farah A; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Mari A; Gastroenterology Unit. |
| Source: | European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2026 Jul 01; Vol. 38 (7), pp. 840-845. Date of Electronic Publication: 2026 May 27. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams And Wilkins Country of Publication: England NLM ID: 9000874 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-5687 (Electronic) Linking ISSN: 0954691X NLM ISO Abbreviation: Eur J Gastroenterol Hepatol Subsets: MEDLINE |
| Imprint Name(s): | Publication: London : Lippincott Williams And Wilkins Original Publication: [London, UK ; Philadelphia, PA, USA] : Current Science, c1989- |
| MeSH Terms: | Heartburn*/ethnology , Heartburn*/drug therapy , Heartburn*/diagnosis , Heartburn*/etiology , Arabs*/statistics & numerical data , Healthcare Disparities*/ethnology , Gastroesophageal Reflux*/ethnology , Gastroesophageal Reflux*/diagnosis , Gastroesophageal Reflux*/drug therapy , Jews*/statistics & numerical data, Proton Pump Inhibitors/therapeutic use ; Antacids/therapeutic use ; Hernia, Hiatal/ethnology ; Histamine H2 Antagonists/therapeutic use ; Barrett Esophagus/ethnology ; Barrett Esophagus/diagnosis ; Humans ; Male ; Retrospective Studies ; Female ; Middle Aged ; Gastroscopy ; Aged ; Adult ; Risk Factors ; Age Factors |
| Abstract: | Background: Persistent heartburn is a common indication for gastroscopy. However, the diagnostic yield and contribution of patient-level factors, including ethnicity, to clinically significant findings (CSFs) remain incompletely defined. Methods: This retrospective cohort included 6813 adults who underwent gastroscopy between 2012 and 2023 for persistent heartburn despite prior acid-suppressive therapy. Arab ( n = 1831) and Jewish ( n = 4982) patients were compared in terms of demographics, treatment history, procedural characteristics, and endoscopic outcomes. Multivariable logistic regression identified independent predictors of CSFs. Results: Arab patients were significantly older than Jewish patients (56.2 ± 18.7 vs. 50.2 ± 14.6 years; P < 0.001), with no difference in sex distribution. Pre-endoscopy treatment differed markedly by ethnicity: Arab patients more frequently received antacids only (17.6 vs. 3.2%) or H2-blockers (18.0 vs. 11.5%), whereas Jewish patients were more likely to receive proton pump inhibitors (PPIs), including high-dose and twice-daily regimens. CSFs were more prevalent among Arabs (18.9 vs. 12.3%; P < 0.001), primarily because of higher rates of Barrett's esophagus and severe reflux esophagitis. Multivariable analysis showed that Arab ethnicity, male sex, older age, and presence of hiatus hernia were independently associated with CSFs, while adequate PPI therapy (particularly prolonged or high-dose regimens) was protective. Conclusion: Gastroscopy in patients with persistent heartburn frequently reveals clinically significant esophageal pathology, particularly among Arab patients. Ethnic disparities in pre-endoscopy management and outcomes suggest that tailored therapy may mitigate disease burden and improve endoscopy utilization. (Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) |
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| Contributed Indexing: | Keywords: Barrett’s esophagus; erosive esophagitis; ethnic disparities; gastroesophageal reflux disease; hiatus hernia; persistent heartburn; proton pump inhibitors; upper endoscopy |
| Substance Nomenclature: | 0 (Proton Pump Inhibitors) 0 (Antacids) 0 (Histamine H2 Antagonists) |
| Entry Date(s): | Date Created: 20260501 Date Completed: 20260715 Latest Revision: 20260716 |
| Update Code: | 20260716 |
| DOI: | 10.1097/MEG.0000000000003202 |
| PMID: | 42065999 |
| Database: | MEDLINE |
| ISSN: | 1473-5687 |
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| DOI: | 10.1097/MEG.0000000000003202 |