Increased incidence of gastroesophageal reflux disease in patients with chronic hepatitis B virus infection.
BACKGROUND
Although chronic liver disease is associated with gastroesophageal reflux disease (GERD), the impact of chronic hepatitis B virus (HBV) infection on this association remains unclear. We thus aimed to evaluate the relationship between chronic HBV infection and GERD.


METHODS
In this prospective population-based study, 1,001 adult subjects who underwent an upper gastrointestinal endoscopic examination in a health check-up and completed a gastroesophageal reflux questionnaire were consecutively enrolled. Endoscopic findings were classified according to the Los Angeles classification. Hepatitis B surface antigen was used as a marker of HBV infection. Univariate and multivariate approaches were used to evaluate the effects of chronic HBV infection on GERD.


RESULTS
Chronic HBV infection was associated with heartburn sensation [odds ratio (OR) 1.27, 95% confidence interval 1.01-1.61, P = 0.037], and erosive esophagitis (adjusted OR 1.75, 1.03-2.97, P = 0.037). Although male gender is a risk factor of erosive esophagitis, further analyses stratified by gender and aspartate aminotransferase to platelet ratio index (APRI) showed that chronic HBV infection was associated with erosive esophagitis in female subjects (adjusted OR 2.70, 1.14-6.39, P = 0.024) and those with APRI of more than 0.3 (adjusted OR 3.94, 1.73-8.96, P = 0.001). Moreover, higher serum aspartate aminotransferase (AST) and triglyceride (TG) levels were risk factors of erosive esophagitis in patients with chronic HBV infection.


CONCLUSIONS
Our findings indicate a close association between chronic HBV infection and GERD, especially in female subjects and those with higher APRI levels. Moreover, HBV carriers with higher AST or TG levels have higher incidence of erosive esophagitis. The interactions between chronic HBV infection and GERD need further studies.


BACKGROUND
The online version of this article (doi:10.1007/s12072-010-9184-4) contains supplementary material, which is available to authorized users.
Ching-Sheng
CS
Hsu
Chia-Chi
CC
Wang
Pin-Chao
PC
Wang
Hans Hsienhong
HH
Lin
Tai-Chung
TC
Tseng
Chien-Hwa
CH
Chen
Wei-Chih
WC
Su
Chun-Jen
CJ
Liu
Chi-Ling
CL
Chen
Ming-Yang
MY
Lai
Pei-Jer
PJ
Chen
Ding-Shinn
DS
Chen
Jia-Horng
JH
Kao