Development Of Erosive Esophagitis Research Articles

The effect of anthropometric and metabolic parameters on the development of erosive reflux disease in patients with gastroesophageal reflux disease

Aims: Gastroesophageal reflux disease (GERD) is a common health problem worldwide. Previous studies have reported that central obesity associated with visceral steatosis is an important problem in digestive system diseases, especially reflux-related diseases. This study aimed to examine the effect of body fat distribution on the development of erosive esophagitis. Methods: A total of 131 individuals, 105 patients and 26 healthy volunteers, were included in this study. The FSSG questionnaire was applied to all individuals. Patients with an FSSG questionnaire score of 10 or more underwent upper gastrointestinal tract endoscopy. Patients with esophagitis on endoscopy were included in the erosive esophagitis group, whereas patients without esophagitis were included in the non-erosive group. Serum biochemistry (fasting glucose, insulin, lipid panel, uric acid, TSH, AST, ALT) analyzes were performed. Waist circumference was measured. Body compositions were evaluated using the bioelectrical impedance method (Tanita). Results: Erosive esophagitis was found in 68 of 105 patients enrolled in the study, and non-erosive esophagitis in 37. There was no statistically significant difference in age, BMI, and waist circumference between the erosive, non-erosive and control groups. The visceral fat percentage was higher in the erosive esophagitis group than the other groups (p <0.001). At the end of the pairwise comparison of the groups, it was found that visceral fat value was higher in the erosive group than the non-erosive and control groups, while the visceral fat value was similar in the control and non-erosive groups. Except for the control group, when comparing the erosive and non-erosive groups, it was found that most of the patients in the erosive group were male, their FFM values and muscle mass were relatively high, and visceral fat values were significantly higher. Conclusion: An increase in visceral fat is a more important risk factor for the development of erosive esophagitis than obesity, waist circumference and increased BMI.

Effect of gastric helicobacter pylori colonization in the development of erosive esophagitis in patients with hiatal hernia.

There may be various factors that determine gastroesophageal reflux disease (GERD) as a result of hiatal hernia (HH) (such as the size of the hernia, age, other host and environmental factors) and the presence of protective factors to explain the absence of reflux disease should not be ignored. Helicobacter pylori (Hp) infection can prevent the development of GERD or cause it. This study aimed to determine whether Hp colonized in the stomach and hernia affects the development of erosive esophagitis (EE) in patients with HH. In this case-controlled study, 111 patients with HH were eligible for the study. Study group with EE (n = 61, 55%) and control group without EE (n = 50, 45%) were formed. Groups were compared for gastric Hp and Hp in the hernia. While the frequency of Hp in the antrum was 55.7% in the group with EE, it was 30% in the control group (p = 0.01, OR: 2.94 in 95% CI 1.34-6.46). The rates in terms of HP frequency in the corpus were 43.6% and 32.1%, respectively, (p = 0.45). Hp colonization in HH was detected in 18 cases (29.50%) and 14 cases (28%), respectively, (p = 0.86). In regression analysis, antral Hp was found to be effective in the development of EE (p = 0.01). As a result of this study, we think that antral Hp may have a causative role in the development of reflux esophagitis, but the presence of Hp in HH does not have an effective role in reflux esophagitis formation.

Association between sitting-time at work and incidence of erosive esophagitis diagnosed by esophagogastroduodenoscopy: a Korean cohort study.

BackgroundMost previous longitudinal studies on lifestyle and gastroesophageal reflux disease (GERD) have focused on physical activity rather than sitting time. The main purpose of this study was to investigate the relationship between prolonged sitting time and the development of erosive esophagitis (EE).MethodsA self-report questionnaire was used for measuring sitting time in the Kangbuk Samsung Health Study. Sitting time was categorized into four groups: ≤ 6, 7–8, 9–10, and ≥ 11 hours/day. Esophagogastroduodenoscopy (EGD) was performed by experienced endoscopists who were unawared of the aims of this study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of EE were estimated using Cox proportional hazards analyses with ≤ 6 hours/day sitting time as the reference.ResultsThere were 6,524 participants included in the study. During a mean follow-up of 3.14 years, 2,048 incident cases developed EE. In age- and sex-adjusted models, the HR in the group sitting ≥ 11 hours per day compared ≤ 6 hours per day was 0.88 (95% CI: 0.76–0.99). After further adjusting for alcohol intake, smoking status, educational level, history of diabetes, and history of dyslipidemia, sitting time was still significantly related to the risk of EE (HR, 0.87; 95% CI: 0.76–0.98). After further adjustment for exercise frequency, this association persisted (HR, 0.86; 95% CI: 0.76–0.98). In subgroup analysis by obesity, the relationship between sitting time and EE was only significant among participants with body mass index < 25 kg/m2 (HR, 0.82; 95% CI: 0.71–0.95).ConclusionsGenerally, prolonged sitting time is harmful to health, but with regard to EE, it is difficult to conclude that this is the case.

ASSESSMENT OF THE INTESTINAL MICROBIOTA IN ADULTS WITH EROSIVE ESOPHAGITIS.

The intestinal microbiota influences the appropriate function of the gastrointestinal tract. Intestinal dysbiosis may be associated with a higher risk of esophageal lesions, mainly due to changes in gastroesophageal motility patterns, elevation of intra-abdominal pressure, and increased frequency of transient relaxation of the lower esophageal sphincter. The aim of this study was to evaluate the intestinal microbiota in individuals with erosive esophagitis and in healthy individuals using metagenomics. A total of 22 fecal samples from adults aged between 18 and 60 years were included. Eleven individuals had esophagitis (eight men and three women) and 11 were healthy controls (10 men and one woman). The individuals were instructed to collect and store fecal material into a tube containing guanidine solution. The DNA of the microbiota was extracted from each fecal samples and PCR amplification was performed using primers for the V4 region of the 16S rRNA gene. The amplicons were sequenced using the Ion Torrent PGM platform and the data were analyzed using the QIIME™ software version 1.8. Statistical analyses were performed using the Mann-Whitney non-parametric test and the ANOSIM non-parametric method based on distance matrix. The alpha-diversity and beta-diversity indices were similar between the two groups, without statistically significant differences. There was no statistically significant difference in the phylum level. However, a statistically significant difference was observed in the abundance of the family Clostridiaceae (0.3% vs 2.0%, P=0.032) and in the genus Faecaliumbacterium (10.5% vs 4.5%, P=0.045) between healthy controls and esophagitis patients. The findings suggest that reduced abundance of the genus Faecaliumbacterium and greater abundance of the family Clostridiaceae may be risk factors for the development of erosive esophagitis. Intervention in the composition of the intestinal microbiota should be considered as an adjunct to current therapeutic strategies for this clinical condition.

Differences in Several Factors in the Development of Erosive Esophagitis Among Patients at Various Stages of Metabolic Syndrome: A Cross-Sectional Study.

BackgroundErosive esophagitis (EE) is strongly associated with metabolic syndrome (MS), but is not always recognized in individuals with MS and the prevalence of EE in individuals with non-MS is not low.AimTo examine the differences in clinical factors associated with EE at various stages of MS, as well as the differences in metabolites between subjects with MS, with and without EE.MethodsA total of 7,097 persons who underwent health checkups including esophagogastroduodenoscopy were analyzed. We examined the differences in clinical factors for EE among subjects with non-MS, pre-MS, and MS and compared metabolites between 34 subjects with MS, with and without EE.ResultsEE prevalence was significantly higher in the MS and pre-MS groups than in the non-MS group (p < 0.001). EE severity was higher in the MS group than in the pre-MS and non-MS groups (p < 0.001). In the non-MS group, there were significant differences between subjects with and without EE with respect to Helicobacter pylori (H. pylori) and smoking. In the pre-MS and MS groups, there were significant differences in H. pylori, hiatal hernia, and drinking in those with and without EE. The levels of glutamine, hypoxanthine, and lactic acid metabolites were significantly different between subjects with MS, with and without EE (all p < 0.05).ConclusionAlthough H. pylori and lifestyle factors such as smoking and drinking are important for EE, differences in these factors should be considered at various stages of MS. Additionally, several metabolites may be involved in the development of EE in MS.

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study.

The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication use, while a minority have implemented objective functional measurements. To better comprehend the pathophysiological mechanisms involved in the genesis of GERD after SG. University Hospital, Italy. A total of 21 patients affected by morbid obesity and eligible for SG were prospectively enrolled in the present study. Patients were evaluated by means of endoscopy, high-resolution manometry (HRM), 24-hour pH monitoring, and the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. Follow-up was completed at least 1 year post operation (mean follow-up, 14.3 ± 2.1 mo) by 19 patients. Body mass index decreased from 41.2 ± .9 to 26.8 ± .8 kg/m2 (P < .001). Distal contractile integral significantly decreased from 2772.8 ± 399.9 mm Hg/s/cm to 2060.4 ± 338.9 mm Hg/s/cm (P = .01). The 24-hour pH monitoring showed an overall reduction tendency of acid reflux, although this was not statistically significant. All analyzed endoscopic findings withstood substantial pejorative modifications after SG (P < .01). Distal contractile integral values at baseline predicted postoperative Z-line upward migration; HRM, distal latency, and DeMeester score at baseline predicted the development of erosive esophagitis at follow-up, by bootstrap estimates of a logistic regression. Postoperative GERD-related esophageal sequelae should be carefully considered after SG. Our results demonstrate how acid reflux does not seem to play a relevant role in the pathophysiology of post-SG GERD. Baseline HRM can help stratify the risk of developing erosive esophagitisand Z-line upward migration after SG, while postoperative endoscopic surveillance should be encouraged regardless of the presence or absence of symptoms.

Effect of Weight Changes on the Development of Erosive Esophagitis.

BackgroundGastroesophageal reflux disease is highly prevalent among overweight and obese individuals. This study aimed to investigate the effect of weight change on the development of erosive esophagitis (EE).MethodsA retrospective review of medical records from a university hospital in South Korea identified 7,123 subjects who underwent routine health checkups in 2012 and 2014. We excluded participants with EE in 2012. Body mass index (BMI) changes were classified as loss, stable, mild gain, or moderate gain.ResultsMild and moderate weight gain increased the odds of EE development (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06–1.84 and OR, 2.80; 95% CI, 1.87–4.21, respectively) relative to weight stability. Weight loss decreased the odds of EE development (OR, 0.58; 95% CI, 0.38–0.90) relative to weight stability. After stratifying subjects into three groups by baseline BMI, those with mild and moderate weight gain in the obese group and moderate gain in the overweight group showed increased odds of EE development relative to members of those groups whose weights remained stable (OR, 2.08; 95% CI, 1.29–3.36; OR, 3.92; 95% CI, 1.99–7.73 in obese group, and OR, 3.30; 95% CI, 1.64–6.64 in overweight group, respectively). In comparison, weight loss in the normal weight group decreased the odds of EE development relative to weight stability (OR, 0.38; 95% CI, 0.15–0.97).ConclusionWeight gain was positively associated with EE development in overweight or obese individuals. Weight loss was negatively associated with EE development in normal-weight individuals.

Clinical, Endoscopic, and Histologic Findings at the Distal Esophagus and Stomach Before and Late (10.5Years) After Laparoscopic Sleeve Gastrectomy: Results of a Prospective Study with 93% Follow-Up.

Perform a prospective study based on sequential clinical, endoscopic, and histologic evaluations of the foregut late after laparoscopic sleeve gastrectomy (LSG) in obese patients. After LSG, several studies have suggested an increase in the incidence of clinical gastroesophageal reflux (GERD) while others have reported an improvement but based mainly on clinical questionnaires. Prospective study of 104 consecutive patients submitted to LSG. Several postoperative endoscopic and histologic evaluations of the esophagogastric junction (EGJ) and the gastric tube (GT) were performed and correlated with symptomatic findings. According to clinical preoperative findings, patients were divided into non-refluxers (Group I) and refluxers (Group II). Seven patients were unreachable, leaving 97 (93%) for late evaluation. Among Group I, 58.5% developed de novo GERD, while in Group II just 13.6% showed the disappearance of them. Endoscopic evaluations showed progressive deterioration of the EGJ in Group I, with the development of erosive esophagitis (EE), hiatal hernia (HH), and dilated cardia in a large proportion of them. In the GT, the presence of bile was seen in 40%, and an open immobile pylorus was detected in 82%. Short-segment Barrett's esophagus (BE) appeared in 4%. Patients submitted to LSG showed a significant and progressive increase in the presence of "de novo" GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a "pro-reflux" surgical procedure, which should be continuously evaluated late after surgery.

Metabolically Healthy Obesity and the Risk of Erosive Esophagitis: A Cohort Study.

OBJECTIVES:Obesity is an established risk factor of erosive esophagitis, and metabolic unhealthiness has been implicated in the pathogenesis of erosive esophagitis. Yet, the risk of erosive esophagitis among obese individuals without obesity-related metabolic unhealthiness, a condition referred to as “metabolically healthy obese (MHO)”, remains unclear. We examined the association between body mass index (BMI) categories and the development of erosive esophagitis in a cohort of metabolically healthy individuals.METHODS:We conducted a cohort study of 14,725 asymptomatic adults free of erosive esophagitis and metabolic abnormalities, who underwent repeated health checkups including screening endoscopy. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. The presence of erosive esophagitis was determined using endoscopy.RESULTS:During 81,385.2 person-years of follow-up, 1,865 participants developed erosive esophagitis (incidence rate, 22.9 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident erosive esophagitis comparing overweight (BMI 23.0–24.9) and obese (≥25) with normal-weight participants (18.5–22.9) were 1.12 (1.00–1.25) and 1.29 (1.14–1.47), respectively. In dose-response analyses, increasing BMI also showed positive association with overall and LA-B grade or higher. The association persisted in MHO individuals without central obesity. The association between waist circumference categories and the development of erosive esophagitis was also evident.DISCUSSION:In a large cohort of strictly defined metabolically healthy men and women, the MHO phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease.

Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy

BackgroundThe postoperative development or worsening of gastroesophageal reflux disease (GERD) represents the major drawback of laparoscopic sleeve gastrectomy (SG). A GERD diagnosis is often based only on symptoms and proton pump inhibitors (PPI) intake, while objective tests like esophagogastroduodenoscopy and pH measurements are performed less frequently. ObjectivesTo evaluate the association between reflux symptoms and GERD-related esophageal lesions. SettingsUniversity hospital, Rome, Italy. MethodsA comprehensive clinical control entailing GERD symptoms, PPI intake, and esophagogastroduodenoscopy was proposed to all patients who underwent SG between June 2007 and February 2011, irrespective of the presence of GERD symptoms. One hundred forty-four of 219 patients agreed to take part in the study (follow-up rate: 65.8%). ResultsAfter a mean follow-up of 66 months, GERD symptoms and PPI intake were recorded in 70.2% and 63.9% of patients, respectively. Mean visual analogue scale score was 2.9 ± 3.3. The overall frequency of erosive esophagitis was 59.8%, while nondysplastic Barrett’s esophagus was detected in 13.1%. The frequency of esophageal biliary reflux was 68%. GERD symptoms and visual analogue scale score were not significantly associated with the development of erosive esophagitis and Barrett’s esophagus and the severity of the esophageal lesions. Moreover, the frequency of erosive esophagitis and Barrett’s esophagus in patients consuming PPI were similar to that of patients without PPI. ConclusionSymptoms investigation alone is not a reliable tool to diagnose GERD after SG. The use of objective diagnostic tests, such as esophagogastroduodenoscopy, should be carefully considered in the postoperative follow-up schedule of SG patients.

Prevalence of endoscopic esophagitis in pediatric gastroesophageal reflux disease and relative indication

Objective: The typical manifestations of gastroesophageal reflux disease (GERD), heartburn and regurgitation, occurs in 2–7% of children but the prevalence of GERD complications is unknown. Aim: Evaluate the prevalence of endoscopic esophagitis (EE) in pediatric patients and the indication to exam performance. Methods:Between January2013andFebruary2014, 72children (median age of children was 13 DS 3 years) underwent to upper endoscopy. Results: The major indication to upper endoscopy was heart burn sensation non responder to acid suppression, 40 (55.5%); epigastralgia and regurgitation 20 (28%); dysphagia 4 (5.5%); anemia 4 (5.5%); intractable vomiting 4 (5.5%). EE was endoscopically documented in 32 patients (44.4%), among which 25 (78.1%) were diagnosed to have mild EE (LA grade A or B). The median age of children with erosive esophagitis was 14 DS 2 years, compared with 10.0 DS 3 years in thosewithout erosive esophagitis (p<0.05). The endoscopic esophagitis is more commune in patients with epigastralgia and regurgitation versus heart burn sensation (55% vs 45%). Conclusions: In conclusion, erosive esophagitis, a complication of GERD, is slightly more common in children and increases with age. The duration of GERD probably, is a risk factor for the development of erosive esophagitis. A previous acid suppression maybe reduces the incidence of EE.

Helicobacter pylori and gastroesophageal reflux disease.

The purpose of the review is to discuss key studies conducted on the intriguing relationship between Helicobacter pylori and gastroesophageal reflux disease. Epidemiological studies have repeatedly described a negative association between H. pylori infection and erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma, but not between H. pylori and gastroesophageal reflux disease symptoms. Especially, infection with CagA-positive strains appears to protect the distal esophagus by causing fundic gland atrophy and impaired gastric acid secretion. Although earlier reports suggested the development of erosive esophagitis after H. pylori eradication, more recent studies discuss that H. pylori eradication usually does not have an important clinical impact on gastroesophageal reflux disease. Gastric atrophy is the most widely accepted mechanism by which the distal esophagus is protected from abnormal acid exposure in patients with H. pylori infection. The clinical impact of H. pylori infection on the prevalence of erosive esophagitis and Barrett's esophagus remains a matter of debate. In areas with a high prevalence of H. pylori-induced atrophic gastritis, the protection that this infection may afford against gastroesophageal reflux disease is not comparable to the risk that H. pylori poses for the development of gastric cancer.

Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett's Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment

Figure 2. The irregularly-shaped resected specimen Sa1455 Development of Erosive Esophagitis During Radiofrequency Ablation for Barrett’s Esophagus Is Associated With an Increased Number of Sessions for Successful Treatment Cary C. Cotton*, W. Asher Wolf, Nan Li, Sarina Pasricha, Kelly E. Hathorn, Melissa Spacek, Susan E. Moist, Ryan D. Madanick, Evan S. Dellon, Nicholas J. Shaheen Center for Esophageal Diseases & Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC Background: Radiofrequency ablation (RFA) is a safe and effective treatment for Barrett’s esophagus (BE). The development of erosive esophagitis (EE) during treatment represents incomplete control of reflux, and may retard reversion to squamous www.giejournal.org Vol epithelium. Methods: We conducted a retrospective study of patients who underwent RFA for dysplastic BE at University of North Carolina Hospitals between March 16, 2006 and August 30, 2013. Patients were excluded for non-dysplastic BE and invasive esophageal adenocarcinoma. We used nonparametric statistics to analyze the impact of EE at the first endoscopy or development of EE during or after ablation on outcomes of RFA. We assessed 3 types of EE: 1) Prevalent EE was defined as EE of any grade at the initial endoscopy in a patient scheduled for RFA, 2) Incident treatment EE was defined as EE on any treatment endoscopy after the first treatment (but before attainment of complete eradication of intestinal metaplasia (CEIM)), and 3) Incident surveillance EE was defined as an initial occurrence of EE after CEIM had been attained, during routine endoscopic surveillance. Outcomes included the number of treatment endoscopies (defined as endoscopies where RFA or endoscopic mucosal resection was performed), the rate of CEIM, and the rate of IM recurrence. Risk factors for the three types of EE were identified. Statistical analysis was performed using SAS software (version 9.3.) Results: Of 302 patients, 283 met inclusion criteria. Of these, 15 patients had prevalent EE, 21 had incident treatment EE, and 17 had incident surveillance EE. Of 55 patients who had EE after the first endoscopy, 12 of these also had prevalent EE. Thus, 26 patients of 268 (9.7%) at risk developed EE during treatment and 17 patients of 201 (8.5%) who entered surveillance without prior EE developed EE during surveillance. Patients with prevalent EE received significantly more treatments (Figure; mean 4.0 vs. 3.0, p Z 0.045.) This association was also found with incident treatment EE (mean 4.0 vs. 2.9, p Z 0.005). Similar associations persisted in linear regression analysis with adjustment for segment length. Neither prevalent EE nor incident treatment EE was significantly associated with failure to reach CEIM. None of the 3 types of EE were significantly associated with intestinal metaplasia (IM) recurrence. Risk factors for prevalent EE or incident treatment EE included BE length, hiatal hernia and tobacco (table). Conclusion: Both prevalent EE at the time of baseline endoscopy as well as the development of EE during treatment are associated with an increased number of treatments necessary for successful reversion to squamous epithelium. Risk factors for prevalent EE and EE during RFA treatment include known risk factors for GERD. Control of GERD may predict the effort necessary to achieve successful reversion to squamous tissue in RFA. Risk Factors for Erosive Esophagitis by Phase of Treatment ume 79, N Prevalent Erosive Esophagitis (n [15) o. 5S : 2014 Incident Treatment Erosive Esophagitis (n[21) GASTROINTEST Incident Surveillance Erosive Esophagitis (n [17) INAL ENDOSCOPY All Patients (n[284) Mean / Percent Mean / Percent Mean / Percent Mean / Percent Age (years) 64.2 (N.S.) 64.1 (N.S.) 64.4 (N.S.) 67.9 BMI (kg/m2) 30.8 (N.S.) 30.7 (N.S.) 33.1 (pZ0.046) 29.7 Treatments (#) 4.0 (pZ0.045) 4.1 (pZ0.005) 2.6 (N.S.) 3.0 Prague M (cm) 5.4 (N.S.) 5.9 (pZ0.002) 3.9 (N.S.) 4.5

The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population - Could It Be Explained?: A Multi-center Prospective Study

Background/AimsResearches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status.MethodsA total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis.ResultsThe prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (≥ 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride ≥ 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level ≥ 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis.ConclusionsThe prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.

Prevalence and risk factors of erosive esophagitis in Taiwan

BackgroundErosive esophagitis is a common condition in the western population. However, the prevalence and risk factors of this disorder in Taiwan remain unclear. This study investigated the current prevalence of erosive esophagitis in Taiwan and attempted to identify the risk factors for this disease. MethodsFrom January 2008 to May 2009, 2040 consecutive subjects who underwent upper gastrointestinal endoscopy during their annual health check-up were enrolled. The severity of erosive esophagitis was evaluated according to the Los Angeles classification, and the independent risk factors of erosive esophagitis were analyzed using the logistic regression method. ResultsThe prevalence of erosive esophagitis was 17.3% (352/2040), with 71.6%, 27.8%, 0.5% and 0% cases of grades A, B, C and D, respectively, according to the Los Angeles classification. Univariate analysis revealed that male sex, smoking, alcohol consumption, betel nut chewing habit, body mass index ≥ 27 kg/m2, hypertension, use of calcium channel blockers, diabetes, hyperglycemia, hypertriglyceridemia, and hiatus hernia were associated with the development of erosive esophagitis. Multivariate analysis revealed that male sex [odds ratio (OR) = 2.013, 95% confidence interval (CI) = 1.439–2.815; p < 0.001), smoking (OR = 1.301, 95% CI = 1.089–1.555; p = 0.004), body mass index > 27 (OR = 1.348, 95% CI = 1.138–1.598; p = 0.001), and hiatus hernia (OR = 4.331, 95% CI = 3.304–5.784; p < 0.001) were independent risk factors for the development of erosive esophagitis. ConclusionThe current prevalence of erosive esophagitis in Taiwan is 17.3%. Male sex, smoking, obesity, and hiatus hernia are four independent risk factors for the development of erosive esophagitis in the Taiwanese population.

What is the Incidence of Barrett's and Gastric Metaplasia in Esophageal Atresia/Tracheoesophageal Fistula (EA/TEF) Patients?

Aim of the study was to document the incidence of gastric and intestinal metaplasia (Barrett's esophagus) in a closely followed group with EA/TEF, determine the efficacy of pH probe studies in diagnosing reflux and, moreover, to determine the lag period between the development of gastroesophageal reflux disease (GERD) and metaplasia. Patients who underwent EA/TEF correction were followed up over an 18-year period (1990-2009) with regular pH probe and endoscopy investigations. Biopsies were performed at 3 year intervals to evaluate for metaplastic changes in the esophageal epithelium. The interval between esophageal atresia correction and the development of erosive esophagitis, gastric metaplasia and Barrett's esophagus was determined. The development of complicated GERD was statistically correlated to age at detection. 51 patients (28 male) underwent EA/TEF correction during the study period. The ages of the children followed up ranged from 7 months to 19 years. There were 5 Type A, 44 Type C and 2 Type D fistulas. 37 patients (5 Type A, 31 Type C, 1 Type D) had documented reflux and 14 did not. 17 (46%) of the patients with reflux underwent an anti-reflux operation. 4 of the 17 underwent 2 or more anti-reflux procedures. 21 patients had pH probe studies positive for reflux, 3 had negative pH probe studies after an anti-reflux operation. 18 of the 37 patients with reflux (about 50%) needed esophageal dilatation for either anastamotic or non-anastamotic strictures. Only 4/14 (28.5%) patients without reflux underwent dilatations and only in their first year of life (p=NS). 15 patients had mucosal abnormalities in endoscopic biopsies. 8 patients had gastric metaplasia and 1 patient had Barrett's esophagus. The mean age in the group with metaplasia (gastric and intestinal) was 13 years, which was significantly different from the mean age of the group (5.2 years) without mucosal changes (p<0.001). 2 patients with normal pH probe studies had metaplasia on biopsies. Metaplasia arises in about 15% of patients with EA/TEF. The lag time to developing metaplasia from the time of initial surgical correction is about 10 years. Endoscopy and biopsies are the best way of detecting mucosal changes.

De novo erosive esophagitis in duodenal ulcer patients related to pre-existing reflux symptoms, smoking, and patient age, but not to Helicobacter pylori eradication: a one-year follow-up study

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers--20-mg omeprazole b.i.d. for 4 weeks was administered. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47-16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34-11.68), and smoking (OR, 3.17; 95% CI, 1.01-9.17). H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis.

Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.

Abdominal Obesity as a Risk Factor for the Development of Erosive Esophagitis in Subjects with a Normal Esophago-Gastric Junction

Background/AimsObesity is reported to be associated with erosive esophagitis (EE). However, the temporal association of obesity and abdominal obesity with EE is unclear. We conducted this study to investigate the temporal association of obesity, especially abdominal obesity with EE.MethodsAmong 1,182 subjects who underwent health screening examinations including upper endoscopy in both 2003 and 2006, a total 1,029 subjects with a normal esophagogastric junction on upper endoscopy in 2003 were enrolled. All subjects completed questionnaires and anthropometric measurements were obtained twice by trained personnels. The patients with newly developed EE were compared to the subjects without newly developed EE.ResultsAmong 1,029 subjects, 42 (4.1%) were newly diagnosed with EE and 82 (8.0%) with hiatal hernia. The mean body mass index (BMI) in both examinations was significantly different between the two groups based on the development of erosive esophagitis (p<0.05 in both examinations). The mean waist circumference (WC) in both examinations was also significantly different between the two groups (p<0.01 in both examinations). The multivariate analysis demonstrated that EE was not associated with the BMI in 2003 and the increase of BMI; however, it was associated with the WC in 2003 (Odds ratio, 7.21; 95% CI, 1.78 to 29.19; >90 cm vs <80 cm).ConclusionsOur study showed that abdominal circumference is an independent risk factor for EE, demonstrating a temporal relationship between abdominal obesity and EE.

Neither genotype nor the gastric colonization site of Helicobacter pylori are predictive factors for the development of erosive esophagitis in patients with peptic ulcer disease, 1 year after eradication

Whether Helicobacter pylori infection is a protective or predisposing factor for the development of gastroesophageal reflux disease remains controversial. The most virulent strains, such as those expressing the cytotoxin-associated gene A (CagA), and the site of gastric colonization have been correlated with the prevention or development of esophagitis. To determine the incidence of erosive esophagitis following eradication of H. pylori in patients with peptic ulcer disease and to evaluate the association of erosive esophagitis with virulent strains of H. pylori and the site of gastric colonization. Triple therapy with lansoprazole, amoxicillin and clarithromycin was administered to 159 patients with peptic ulcer disease. Endoscopy, histopathology, urease and carbon-14 urea breath tests were performed prior to treatment, at 3 months and 1 year following treatment. Genotyping of H. pylori strains using polymerase chain reaction was performed separately on samples from the corpus and antrum. One year after treatment, 148 successfully treated patients were reevaluated. Twenty-eight patients (19%) had erosive esophagitis, classified as Los Angeles grade A in 24 and B in 4. The samples taken from the corpus were CagA-positive in 18 patients (64%), while the samples taken from the antrum were CagA-positive in 21 patients (75%). The incidence of erosive esophagitis in peptic ulcer patients who had their H. pylori eradicated was 19%. No correlation was found between the gastric site colonized by H. pylori or strains expressing CagA and the prevention or development of erosive esophagitis in patients with peptic ulcer disease, 1 year after infection eradication.