Abstract
IntroductionErosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania.MethodsA case–control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013–June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms.ResultsPatients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7–5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6–7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9–7.3).ConclusionOur findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.
Highlights
Erosive reflux esophagitis caused a large clinical spectrum of symptoms
The erosive reflux esophagitis was graded according to the Los Angeles (LA) classification criteria based on the extent of visible erosions: grade A, one or more mucosal breaks no longer than 5 mm, none of which extends between the tops of the mucosal folds; grade B, one or more mucosal breaks more than 5 mm long, none of which extends between the tops of the mucosal folds; grade C, mucosal breaks that extend between the tops of two or more mucosal folds, but which involve less than 75% of the esophageal circumference; and grade D, mucosal breaks which involve at least 75% of the esophageal circumference
The association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (Table 3, model 4)
Summary
Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Erosive reflux esophagitis is the most common esophageal complication of gastroesophageal reflux disease (GERD) causing a large clinical spectrum of symptoms. The reflux of gastric contents into the esophageal lumen may involve the esophageal mucosa, but may damage the extra-esophageal tissues such as oropharynx, larynx, and respiratory tract. It is well-known that heartburn and acid regurgitation are typical esophageal symptoms of GERD [1], whereas common extra-esophageal manifestations include throat clearing, sore throat, chronic cough and asthma [1,2,3]. There are insufficient data on the clinical characteristics of GERD in patients with laryngeal or respiratory symptoms [9, 10]
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