Wei Yanbin, Liu Endian, Peng Jiafei, Liu Yanqing, Sun Xiujing, Yao Xin
State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Department of Computer Science and Engineering, University of California, Santa Cruz, Santa Cruz, 95064, USA.
BMC Gastroenterol. 2025 Jul 21;25(1):528. doi: 10.1186/s12876-025-03988-8.
Esophageal diseases (ED) are a common category of upper gastrointestinal disorders, mainly including gastroesophageal reflux disease (GERD), esophagitis, Barrett's esophagus, achalasia, and esophageal cancer (EC). In recent years, the high recurrence rate of GERD and poor prognosis of EC are paid more attention, collectively contributing to the global burden of ED.
For this study, we systematically analyzed the global distribution of ED from 1990 to 2021, detailing the burden across different countries, regions, and socio-demographic index (SDI) levels. Furthermore, we explored temporal trends in ED burden over this period and conducted decomposition analysis, health inequality analysis, and frontier analysis. Finally, we projected trends in ED burden from 2022 to 2045, and quantify contributions of associated risk factors to disability-adjusted life years (DALYs) of EC.
The absolute numbers of incidence, mortality, and DALYs for GERD and EC showed increasing trends from 1990 to 2021, while their age-standardized rates (ASRs) demonstrated divergent patterns: stable for GERD and declining for EC. The highest ASRs were observed in low-middle SDI regions for GERD and high-middle SDI regions for EC, respectively, with population as a main driver. If current trends continue, the burden of GERD will continue to rise, whereas that of EC will persistently decline by 2045. In 2021, DALYs of EC were mainly attributed to smoking (36.5%) and alcohol use (16.2%).
For GERD and EC, the global burden continued to rise and decline from 1990 to 2021, respectively. Developing targeted public health strategies in different countries and regions is crucial for alleviating the global burden of ED.
食管疾病（ED）是上消化道疾病的常见类型，主要包括胃食管反流病（GERD）、食管炎、巴雷特食管、贲门失弛缓症和食管癌（EC）。近年来，GERD的高复发率和EC的不良预后受到更多关注，共同构成了全球ED负担。
在本研究中，我们系统分析了1990年至2021年ED的全球分布情况，详细阐述了不同国家、地区和社会人口指数（SDI）水平的负担情况。此外，我们探讨了这一时期ED负担的时间趋势，并进行了分解分析、健康不平等分析和前沿分析。最后，我们预测了2022年至2045年ED负担的趋势，并量化了相关危险因素对EC伤残调整生命年（DALY）的贡献。
1990年至2021年，GERD和EC的发病率、死亡率及DALY的绝对数量呈上升趋势，而其年龄标准化率（ASR）呈现出不同模式：GERD稳定，EC下降。GERD的ASR在中低SDI地区最高，EC的ASR在中高SDI地区最高，人口是主要驱动因素。如果当前趋势持续下去，GERD的负担将继续上升，而到2045年EC的负担将持续下降。2021年，EC的DALY主要归因于吸烟（36.5%）和饮酒（16.2%）。
1990年至2021年，GERD和EC的全球负担分别持续上升和下降。在不同国家和地区制定有针对性的公共卫生策略对于减轻全球ED负担至关重要。
