title: Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study.
abstract: OBJECTIVE
  To assess the clinical characteristics of patients with complicated erosive esophagitis (EE) and their associated factors.
  
  
  METHODS
  This prospective, cross-sectional study included patients diagnosed with EE by upper gastrointestinal endoscopy between October 2014 and March 2015 at 106 Japanese hospitals. Data on medical history, general condition, gastrointestinal symptoms, lifestyle habits, comorbidities, and endoscopic findings were collected using a standard form to create a dedicated database. Logistic regression analysis was used to calculate adjusted odds ratios (aOR) and 95%CI for the association with complicated EE.
  
  
  RESULTS
  During the study period, 1749 patients diagnosed with EE, 38.3% of whom were prescribed proton pump inhibitors (PPIs) were included. Of them, 143 (8.2%) had EE complications. Esophageal bleeding occurred in 84 (4.8%) patients, esophageal strictures in 45 (2.6%) patients, and 14 (0.8%) patients experienced both. Multivariate analysis showed that increased age (aOR: 1.05; 95%CI: 1.03-1.08), concomitant use of psychotropic agents (aOR: 6.51; 95%CI: 3.01-13.61), and Los Angeles grades B (aOR: 2.69; 95%CI: 1.48-4.96), C (aOR: 15.38; 95%CI: 8.62-28.37), and D (aOR: 71.49; 95%CI: 37.47-142.01) were significantly associated with complications, whereas alcohol consumption 2-4 d/wk was negatively associated (aOR: 0.23; 95%CI: 0.06-0.61). Analyzing associated factors with each EE complication separately showed esophageal ulcer bleeding were associated with increased age (aOR: 1.05; 95%CI: 1.02-1.07) and Los Angeles grades B (aOR: 3.60; 95%CI: 1.52-8.50), C (aOR: 27.61; 95%CI: 12.34-61.80), and D (aOR: 119.09; 95%CI: 51.15-277.29), while esophageal strictures were associated with increased age (aOR: 1.07; 95%CI: 1.04-1.10), gastroesophageal reflux symptom (aOR: 2.51; 95%CI: 1.39-4.51), concomitant use of psychotropic agents (aOR: 11.79; 95%CI: 5.06-27.48), Los Angeles grades C (aOR: 7.35; 95%CI: 3.32-16.25), and D (aOR: 20.34; 95%CI: 8.36-49.53) and long-segment Barrett's esophagus (aOR: 4.63; 95%CI: 1.64-13.05).
  
  
  CONCLUSIONS
  Aging and severe EE were common associated factors, although there were more associated factors in esophageal strictures than esophageal ulcer bleeding. Despite the availability and widespread use of PPIs, EE complications are likely to remain a problem in Japan owing to the aging population and high-stress society.
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ueki
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Miwa
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Inaba
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Norimasa
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Saito
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nakada
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Iwakiri
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.affiliation: Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D001471:Barrett Esophagus / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004935:Esophageal Diseases / Q000453:epidemiology* / Q000209:etiology; D004940:Esophageal Stenosis / Q000453:epidemiology* / Q000209:etiology; D004942:Esophagitis, Peptic / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000188:drug therapy
chemical_list: D054328:Proton Pump Inhibitors; D011619:Psychotropic Drugs
keywords: Complication; Erosive esophagitis; Esophageal stricture; Esophageal ulcer bleeding; Proton pump inhibitor