Risk Factor of Erosive Esophagitis for Adults with Normal Z-Line in Korea

Abstract

Backgrounds: About one-third to one-half of GERD patients has erosive esophagitis. Prevalence of erosive esophagitis is gradually rising in Korea. There have been many cross-sectional studies on risk factors of erosive esophagitis. However, the risk factor of erosive esophagitis occurred in adults with normal Z-line is not well known. Aims: In this study, we investigated the incidence and risk factor of erosive esophagitis in adults with normal Z-line. Patients and Methods: We did a study on a consecutive series of subjects who underwent gastrofiberscopy for stomach cancer screening at the Center for Health Promotion, Korea university Ansan hospital in Korea, from January 2002 to December 2004. A total of 11,288 patients were screened. Of these, 1221 subjects who had normal Z-line with follow up period of more than two years were eligible for this study. Subjects were asked to answer a questionnaire on their education level, alcohol intake, smoking habit, amount of exercise, stress score and comorbidity. Waist circumference and body mass index was checked along with serum laboratory tests. Abdominal sonogram was performed to assess the presence of fatty liver. Gastrofiberscopy was performed during the follow up. Erosive esophagitis was subgrouped according to endoscopic findings of grade M (minimal change) and Los Angeles Classification. Grade M included blurred Z-line and whitish discoloration or hyperemia of distal esophagus. Results: Mean follow up time was 34.4 months (24∼58). Erosive esophagitis occurred in 133 patients (10.9%). From those who had erosive esophagitis, 86 cases were grade M (7.0%), 41 were LA-A (3.4%) and 6 were LA-B (0.5%). However, none was found to have more than LA-C. In univariate analysis, gender, education level, amount of alcohol intake and smoking, waist circumference, serum triglyceride and uric acid level proved to be a risk factor of erosive esophagitis. In Multivariate analysis, only waist circumference proved to be a significant risk factor. Conclusions: Incidence of erosive esophagitis in adults with normal Z-line was 10.9%. Waist circumference can be a predicting factor for erosive esophagitis.