title: Role of hiatus hernia and gastric mucosal atrophy in the development of reflux esophagitis in the elderly.
abstract: OBJECTIVE
  The pathogenetic mechanism responsible for the increased prevalence of reflux esophagitis in the elderly remains controversial. The aim of this study was to determine if an increased occurrence of hiatus hernia (HH) and/or a lower rate of gastric mucosal atrophy (GMA) are the main causes of the increased prevalence of reflux esophagitis in elderly patients.
  
  
  METHODS
  The prevalence of HH, GMA, and reflux esophagitis was investigated by reviewing the endoscopic films of 2788 consecutive patients examined during a 3-year period.
  
  
  RESULTS
  The prevalence of esophagitis in males was higher than in females (11.6% vs 7.6%, P< 0.0005). The prevalence of reflux esophagitis and HH was found to increase with age in females, but not in male patients. The prevalence of reflux esophagitis in hernia-positive patients also increased with age in women, but not in men. Age, male gender, presence of HH, and closed-type of GMA were significant risk factors for the prevalence of esophagitis (P=0.0001, 0.0229, <0.0001, <0.0001, respectively). In addition, the risk ratios of HH and low-grade GMA for reflux esophagitis increased with age, and this tendency was higher in female patients than in males.
  
  
  CONCLUSIONS
  Aging, male gender, HH and closed-type GMA are most likely the risk factors of endoscopically proven reflux esophagitis in Japanese patients.
authors.affiliation: Department of Internal Medicine II, Shimane Medical University, Izumo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Amano
authors.forename: K
authors.initials: K
authors.lastname: Adachi
authors.forename: T
authors.initials: T
authors.lastname: Katsube
authors.forename: M
authors.initials: M
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000473:pathology / Q000502:physiology*; D001284:Atrophy / Q000150:complications / Q000453:epidemiology; D004942:Esophagitis, Peptic / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006551:Hernia, Hiatal / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012737:Sex Factors