Sirs, We read with interest the article by Wong et al. on the prevalence of gastro-oesophageal reflux disease (GERD) in a Chinese population1 and that by Spechler et al. on racial differences in GERD.2 We would like to share our own data on racial disparity in the prevalence of heartburn in an ethnically mixed non-migrant Asian population.

The prevalence of GERD amongst Asians has been reported to be low and has been attributed to a lack of a word for heartburn in the Chinese language, the smaller body mass of Asians, the low-fat Asian diet3 and the high prevalence of Helicobacter pylori infection.4 Indeed, there is no word for heartburn in certain other languages spoken in Asia, e.g. Tamil and Malay. Not surprisingly, Spechler et al. found significant differences amongst racial groups in the reporting, understanding and experience of heartburn, which were exceedingly low in East Asians (2.6%) when compared with Caucasians (34.6%) and Afro-Americans (46.1%).2

Studies from Taiwan report prevalence rates for erosive oesophagitis and Barrett's oesophagus of 15% and 2%, respectively, both of which approach those of published Western reports.5, 6 Our own data from Malaysia reveal a prevalence rate of endoscopically documented oesophagitis of 6% and a similar value for biopsy-proven Barrett's oesophagus8 (both long and short segments), i.e. not dissimilar to published Western data.7 In view of the conflicting prevalence data on GERD in different geographical locations within Asia and the ethnic differentiation in the prevalence of oesophagitis and Barrett's metaplasia, we studied the prevalence of heartburn and health care-seeking behaviour in a multi-racial population. Furthermore, we sought to determine the proportion seeking treatment for GERD, be it Western or alternative medicine.