Background factors of reflux esophagitis and non-erosive reflux disease: a cross-sectional study of 10,837 subjects in Japan.
BACKGROUND
Despite the high prevalence of gastroesophageal reflux disease (GERD), its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE) and non-erosive reflux disease (NERD), and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy.


METHODS
We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20-87 years) who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC), odds ratio (OR), and p-value.


RESULTS
Of the 10,837 study subjects, we diagnosed 733 (6.8%) as RE and 1,722 (15.9%) as NERD. For RE, male gender (SC = 0.557, OR = 1.75), HP non-infection (SC = 0.552, OR = 1.74), higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64), higher BMI (SC = 0.464, OR = 1.60), alcohol drinking (SC = 0.161, OR = 1.17), older age (SC = 0.148, OR = 1.16), and smoking (SC = 0.129, OR = 1.14) are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11), female gender (SC = 0.099, OR = 1.10), younger age (SC = 0.099, OR = 1.10), higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10), smoking (SC = 0.080, OR = 1.08), higher BMI (SC = 0.078, OR = 1.08), and alcohol drinking (SC = 0.076, OR = 1.08) are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001), whereas that of NERD shows no difference (18.2% and 20.8%; p = 0.064).


CONCLUSIONS
Significantly associated factors of NERD are considerably different from those of RE, indicating that these two disorders are pathophysiologically distinct. Eradication of Helicobacter pylori may have disadvantageous effects on RE but not on NERD.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Chihiro
C
Minatsuki
Nobutake
N
Yamamichi
Takeshi
T
Shimamoto
Hikaru
H
Kakimoto
Yu
Y
Takahashi
Mitsuhiro
M
Fujishiro
Yoshiki
Y
Sakaguchi
Chiemi
C
Nakayama
Maki
M
Konno-Shimizu
Rie
R
Matsuda
Satoshi
S
Mochizuki
Itsuko
I
Asada-Hirayama
Yosuke
Y
Tsuji
Shinya
S
Kodashima
Satoshi
S
Ono
Keiko
K
Niimi
Toru
T
Mitsushima
Kazuhiko
K
Koike
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004942:Esophagitis, Peptic / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000517:prevention & control; D016480:Helicobacter pylori / Q000502:physiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors