title: Predictive factors of silent reflux in subjects with erosive esophagitis.
abstract: BACKGROUND
  Asymptomatic erosive esophagitis by definition is a condition lacking any reflux symptom.
  
  
  OBJECTIVE
  We aimed to investigate the prevalence of asymptomatic erosive esophagitis in a general population undergoing periodic health checkup.
  
  
  METHODS
  Consecutive subjects undergoing a medical checkup were enrolled for evaluation of reflux disease with upper endoscopy and a validated reflux questionnaire. The presence and severity of erosive esophagitis were evaluated. In all subjects, demographic characteristics and biochemical data were recorded, and sleep and psychological characteristics were assessed by means of self-administered Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score.
  
  
  RESULTS
  Of 2568 subjects eligible for this study, erosive esophagitis was found in 676 subjects (26.3%), in whom the proportions of asymptomatic and symptomatic erosive esophagitis were 59.2% (400 subjects) and 40.8% (276 subjects) respectively. At a univariate analysis, it was found that asymptomatic erosive esophagitis subjects were more frequently of female gender, of older age, with a lower level of education. They also showed less alcohol and tea consumption, less depression, less anxiety, lower serum level of triglyceride, and lower prevalence of metabolic syndrome. Multivariate analysis revealed that female sex (OR = 1.645, p = 0.0146) was a positive predictive factor for asymptomatic erosive esophagitis, whereas higher level of education (OR = 0.564, p = 0.044), higher Taiwanese Depression Questionnaire score (OR = 0.922, p < 0.001), and the presence of metabolic syndrome (OR = 0.625, p = 0.0379) were negative predictive factors.
  
  
  CONCLUSIONS
  Asymptomatic erosive esophagitis is a common feature in otherwise healthy subjects and is independently associated with female gender, lower education level, less depression, and lower prevalence of metabolic syndrome.
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Lei
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
authors.forename: Hao-Chun
authors.initials: HC
authors.lastname: Yu
authors.affiliation: Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wen
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Tso-Tsai
authors.initials: TT
authors.lastname: Liu
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taiwan.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taiwan.
authors.forename: Ching-Sheng
authors.initials: CS
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taiwan.
authors.forename: Chien-Hwa
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: harry.clchen@msa.hinet.net.
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milano, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pace
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D004522:Educational Status; D004941:Esophagitis / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013662:Tea; D014280:Triglycerides / Q000097:blood
chemical_list: D013662:Tea; D014280:Triglycerides
keywords: Erosive esophagitis; Gastroesophageal reflux; Silent reflux