Influence of age and sex on endoscopic findings of gastrooesophageal reflux disease

Abstract

Barrett's oesophagus (BO) and oesophageal adenocarcinoma are more common with increasing age and among men. Symptoms of gastrooesophageal reflux disease are equally common in both sexes and at all ages. We hypothesized that reduced postmenopausal female sex hormone levels may remove protection from acid reflux injury, leading to increased oesophagitis and its complications in older women. To examine the incidence of gastrooesophageal reflux disease and its complications in men and women in a large endoscopy database. Anonymized data were extracted from endoscopy databases covering an 11-year period. Patients with an endoscopic diagnosis of reflux oesophagitis (RO), BO, hiatus hernia and benign oesophageal stricture and total number and indications for endoscopies were identified. Out of 154 406 upper gastrointestinal endoscopies, 24 240 (15.7%) patients had RO {13,148 male, 11,092 female, mean age 59 [standard deviation (SD) 17] years}. The incidence of RO increased with age {odds ratio 1.029 [95% confidence interval (CI) 1.026-1.032], P<0.001} but this increase was more marked in women with increasing age [1.01 (1.01-1.02), P<0.001] compared with men. Increasing age was associated with an increased incidence of benign oesophageal stricture [1.02 (1.017-1.023)] and BO [1.02 (1.019-1.021)]. Although the increase in benign oesophageal stricture was more marked in women [1.024 (1.02-1.028) P<0.001] than in men, this was not the case in BO. RO and its complications, BO and benign oesophageal stricture increase with age. RO, BO and stricture are more common in absolute and relative terms among younger men than younger women. RO and stricture increase more rapidly in women than men so that the prevalence in elderly patients is similar in both sexes.