Endoscopic Reflux Esophagitis Research Articles

Endoscopic reflux esophagitis and decline in pulmonary function in nonsmokers: A retrospective cohort study

BackgroundThe association between reflux esophagitis and pulmonary function remains controversial. Thus, evaluating the relationship between endoscopic reflux esophagitis and changes in pulmonary function over time in a nonsmoking population is an important clinical issue. MethodsIn this single-center retrospective cohort study, a medical examination database at Kameda Medical Center Makuhari was employed to identify nonsmokers who underwent upper gastrointestinal endoscopy and spirometry in 2010 and were followed up in 2015. Gastroenterologists carefully double-checked the diagnosis of reflux esophagitis. Multiple linear regression analyses were performed to compare the decline in the percentage of predicted vital capacity (%VC), forced vital capacity (%FVC), and forced expiratory volume in 1 s (%FEV1) between participants with reflux esophagitis and those without. Furthermore, using multivariable logistic regression analyses, we evaluated the factors associated with rapid decline in %VC, %FVC, and %FEV1, which is defined as a decrease of >10% in each parameter over the 5-year observation period. ResultsWe identified 3098 eligible subjects, including 72 and 44 participants who had a Los Angeles classification grade A and B–C (severe) reflux esophagitis in 2010, respectively. The decline in %VC was significantly larger in the participants with severe reflux esophagitis than in the control subjects (standardized coefficient, −0.037; 95% confidence interval, −0.071 to −0.004). Moreover, reflux esophagitis was significantly associated with a rapid decline in %VC and %FVC but not in %FEV1 (P for trend: 0.009, 0.009, and 0.276, respectively). ConclusionsSevere reflux esophagitis among nonsmokers had clinical disadvantages in terms of a decline in %VC.

Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer.

Laparoscopic proximal gastrectomy (LPG) is increasingly preferred for operative management of early gastric cancer, although there is no consensus on a standard reconstruction method after resection. Two popular methods used after LPG are double tract reconstruction (DTR) and double flap technique (DFT). This study assessed comprehensive clinical outcomes including quality of life (QoL) and body composition change 1year after DFT and DTR. We retrospectively reviewed prospectively collected data from 51 to 18 patients who underwent DTR and DFT, respectively, between September 2014 and December 2018. Short-term surgical outcomes, presence of reflux esophagitis, nutritional supplementation, medications, nutritional status (laboratory results and body composition analysis), and QoL measured preoperatively and at 1year postoperatively were compared between both groups. Both groups did not differ significantly in clinicopathological characteristics. The DFT as compared to the DTR group required significantly longer time for anastomosis (79.4 vs. 60.9min, p < 0.001) and use of fewer staplers (3.39 vs. 6.86, p < 0.001). While the presence of endoscopic reflux esophagitis and iron/vitamin B12 replacement were comparable, the DTR group showed a higher tendency of taking anti-reflux medications for reflux symptoms (DTR: 13.7% vs. DFT: 0.0%, p = 0.177). The DTR group lost significantly more weight (p = 0.038) and body fat (p = 0.009). QoL analysis showed significant deterioration in diarrhea, eating restriction, and taste problems in both groups (DTR group: p = 0.008, p < 0.001, p = 0.010, respectively, and DFT group: p = 0.017, p = 0.024, p = 0.034, respectively). However, only the DTR group showed significant deterioration in physical function (p = 0.009), role function (p = 0.033), nausea/vomiting (p = 0.041), appetite loss (p = 0.019), dysphagia (p = 0.001), pain (p = 0.025), and body image (p = 0.004). Despite requiring a longer anastomosis time, performing DFT after LPG was shown to be an ideal reconstruction method in terms of better 1-year QoL and nutritional outcome. Further larger studies over longer postoperative periods are necessary to confirm our findings.

Roux-en-Y Reconstruction Following Distal Gastrectomy Reduced Endoscopic Reflux Esophagitis in Older Adults: Propensity Score–Matching Analysis

Objective This study aimed to examine the functional outcomes of Roux-en-Y (RY) and Billroth I (BI) reconstruction methods following distal gastrectomy in patients ages ≥75 years with gastric cancer. Summary of background data RY and BI reconstructions are commonly performed after distal gastrectomy. However, no study has compared the 2 procedures in older adults. Methods We identified older patients who underwent RY (n = 103) or BI (n = 71) reconstruction following distal gastrectomy from 2011 to 2018 in our database. Patients in the RY and BI groups were matched by propensity scores, and each group included 62 patients. We compared short-term surgical outcomes and clinical findings at 1 year postoperatively. Additionally, risk factors for endoscopic reflux esophagitis following distal gastrectomy were evaluated. Results Reflux esophagitis, bile reflux, and remnant gastritis were significantly less frequent in RY reconstruction than in BI reconstruction. Moreover, both BI reconstruction and preoperative hiatus hernias were independent risk factors for postoperative endoscopic reflux esophagitis. Although the incidence of postoperative surgical complications following RY and BI was similar, RY was found to cause delayed gastric emptying more frequently than BI. Conclusion RY reconstruction is a favorable procedure to prevent reflux esophagitis in older patients, particularly in those with hiatal hernia.

Clinical Outcome of Novel Reconstruction of Double Shouldering Technique after Proximal Gastrectomy.

PurposeVarious reconstruction methods have been proposed to reduce reflux after proximal gastrectomy, and we report here a double shouldering technique. The purpose of this study is to compare the novel double shouldering technique with conventional esophagogastrostomy in terms of short term and 3-year clinical outcome.MethodsA retrospective observational case control study was performed on 63 patients for cT1N0 upper third gastric cancer who underwent proximal gastrectomy from January 2012 to November 2016 at the National Cancer Center, Korea. There were 26 patients with conventional esophagogastrostomy, and 37 patients with novel double shouldering technique. The primary outcome was endoscopic reflux esophagitis findings one and three year after surgery according to Los Angeles classification. Secondary outcomes were short term surgical outcome and reflux symptom.ResultsThere was no significant difference in reflux esophagitis on endoscopic findings at 1 and 3 years after surgery between the two group. The double shouldering (DS) technique group showed significantly better postoperative outcomes with bile reflux at one and three years via endoscopic findings versus conventional esophagogastrostomy (CEG). Operative time and hospital stay were significantly shorter in the CEG group than the DS group. There was no significant difference in terms of reflux symptoms and complications.ConclusionThis novel DS technique is a reconstruction method for use after proximal gastrectomy. It did not show a significant clinical benefit. Development of surgical techniques and further study is needed to identify the optimal reconstruction method after proximal gastrectomy.

Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis.

Backgrounds: The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and Helicobacter pylori eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. Methods: We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing H. pylori eradication therapy in a randomized placebo-controlled trial (Category A); between patients with successful and failed eradication (Category B); and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment H. pylori-positives (Category C). Results: A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16–1.84, p = 0.01] or de novo reflux esophagitis (RR: 1.42, 95% CI: 1.01–2.00, p = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Conclusions: Eradication therapy for H pylori increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.

Lifestyle- and Comorbidity-Related Risk Factors Associated with Prescription of Gastric Acid Secretion Inhibitors to Japanese Patients Who Were Helicobacter pylori Negative and Had No Upper Gastrointestinal Lesions

Objective: The aim of this study was to determine the characteristics of patients without Helicobacter pylori infection who were prescribed antacid medications (potassium-competitive acid blockers, proton pump inhibitors, and/or H₂ receptor antagonist) and had no upper gastrointestinal lesions detected by endoscopy. Methods: This cross-sectional study included the patients who underwent upper gastrointestinal endoscopy in our institution between August 2017 and July 2018. They were aged from 55 to 89 years, had no upper gastrointestinal lesions detected by endoscopy, and no H. pylori infection. Exclusion criteria comprised low-dose aspirin and/or nonsteroidal anti-inflammatory drugs. The subjects were allocated to middle-aged (55–69 years) and older age groups (70–89 years). The relationships between antacid medications and patient lifestyle and comorbidities were evaluated by multivariate analyses. Results: Of the 420 patients, 272 were in the middle-aged group and 148 patients in the older age group. Age was found to be a risk factor for antacid medications in both groups (p = 0.002, p = 0.007). No other lifestyle related factors were risk factors. As to comorbidities, hiatal hernia was positively associated with antacid medications in the middle-aged group (p = 0.002). Hypertension and Ca-blockers were positively associated with prescription of antacids in the older age group (p = 0.013); this association was not significant in the middle-aged group. Conclusions: Three lifestyle-related and/or comorbidity-associated factors known to exacerbate gastroesophageal reflux, namely, age, hiatus hernia, and Ca-blockers, were associated with prescription of antacid medications, even in patients without endoscopic reflux esophagitis.

Initial Experience of Endoscopic Radiofrequency Waves Delivery to the Lower Esophageal Sphincter (Stretta Procedure) on Symptomatic Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy.

Gastroesophageal reflux disease (GERD) occurs de novo or intensifies after sleeve gastrectomy (LSG). Endoscopic radiofrequency (Stretta) is a minimally invasive, effective tool to treat GERD. However, Stretta safety and efficacy are unknown in patients with GERD after LSG. To evaluate the safety and efficacy of Stretta treatment post-LSG GERD, quality of life, and PPI dose up to 6months. A retrospective review of all patients' data who underwent Stretta procedure in our center. Demographics, pre-Stretta lower esophageal manometry, 24-h pH monitoring, endoscopic and radiological findings, GERD symptoms using Quality of Life (HR-QoL) questionnaire, and PPI doses at 0, 3, and 6months were reviewed. Fifteen patients had an initial BMI of 44.4 ± 9kg/m2. Pre-Stretta BMI was 29.7 ± 6.3kg/m2 with an EWL% of 44 ± 21.4%. Pre-Stretta endoscopic reflux esophagitis was found in 26.7%, and barium imaging showed severe reflux in 40%. The mean DeMeester score was 27.9 ± 6.7. Hypotensive LES pressure occurred in 93.3% of patients. Patients' mean HR-QoL scores were 42.7 ± 8.9 pre-Stretta and 41.8 ± 11 at 6months (P = 0.8). One case (6.7%) was complicated by hematemesis. At 6months, 66.7% of patients were not satisfied, though the PPI medications were ceased in 20%. Two patients (13.3%) underwent Roux-en-Y gastric bypass at 8months post-Stretta to relieve symptoms. Stretta did not improve GERD symptoms in patients post-LSG at short-term follow-up, and about 6.7% complication rate was reported. Patients were not satisfied despite the decrease in PPI dose.

Risk Factors for Helicobacter pylori Infection and Endoscopic Reflux Esophagitis in Healthy Young Japanese Volunteers.

Objective The aim of this study was to determine the prevalence and risk factors of reflux esophagitis and Helicobacter pylori (H.pylori) infection and their interrelationship in healthy young Japanese volunteers. Methods Between 2010 and 2016, 550 fifth-year medical students at Saga Medical School, aged 22 to 30 years, underwent upper gastrointestinal endoscopy and completed a questionnaire (frequency scale for symptoms of gastroesophageal reflux disease). H. pylori infection was determined by detecting urinary immunoglobulin G antibodies. Results H. pylori antibodies were detected in 45 of the 550 subjects (8.2%). Endoscopic reflux esophagitis was detected in 38 out of 550 (6.9%): grade A in 37 subjects (97.3%) and grade B in 1. Most subjects with reflux esophagitis were H. pylori-negative (35/37). Nodular gastritis was observed in 33.3% (15/45) of H. pylori-positive subjects. The risk factors for H. pylori infection were drinking well water in childhood, nodular gastritis, and duodenal ulcer scars. The risk factors for endoscopic reflux esophagitis were male gender and obesity (body mass index ≥25). Conclusion This study describes the risk factors for H. pylori infection and reflux esophagitis in healthy young Japanese subjects. The prevalence of reflux esophagitis was relatively high, and the infection rate of H. pylori was low compared with the aged Japanese population.

Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer

Objectives: To clarify the optimal length of the antral cuff (LAC) in patients after pylorus-preserving gastrectomy (PPG), we investigated relationships between LAC and postgastrectomy disorder (PGD) such as postprandial abdominal fullness (PAF), and between LAC and gastric empting function (GEF) in PPG patients. Background: The main cause of PGD in PPG patients has been considered to be LAC. Relationships between LAC and PGD and GEF in PPG patients are still unknown. Methods: Of 50 patients who underwent PPG in our hospital from January 2001 to December 2015 were divided into 2 groups [Group A, short LAC of 1.5 to 2.5 cm (n = 24); Group B, long LAC of 2.6 to 3.5 cm (n = 26)]. The relationships among LAC, PGD, and GEF were retrospectively studied. Results: LAC was clearly shorter in group A than group B (P < 0.01). PAF, appetite and food consumption per meal were clearly more favorable in group B than in group A (P < 0.01, respectively). Symptomatic reflux esophagitis (RE), early dumping syndrome, decreased percent body weight for pre-illness, endoscopic RE and endoscopic gastritis in the remnant stomach were more frequent in group A than group B. Gastric stasis in the remnant stomach was clearly more frequent in group A than group B (P < 0.01). GEF with the solid diet in group A was clearly more delayed than in group B (P < 0.01). Conclusions: Patients with a short LAC showed worse postoperative QOL and delayed GEF with the solid diet compared with a long LAC.

A Clinical Case Report of Endoscopic Reflux Esophagitis with Gastric Dysmotility Treated with Korean Traditional Medical Therapy

A Clinical Case Report of Endoscopic Reflux Esophagitis with Gastric Dysmotility Treated with Korean Traditional Medical Therapy

Helicobacter pylori eradication and gastroesophageal reflux disease: a Meta-analysis

To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms. PubMed, CENTRAL, Embase, CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H. pylori eradication treatment and those without treatment. The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring. A Meta-analysis was conducted by using RevMan 5.20 software. Twenty RCTs involving 6 575 cases were included. Meta-analysis showed that: (1) There was a positive link between H. pylori eradication and endoscopic reflux esophagitis. The diagnostic rate of endoscopic reflux esophagitis after H. pylori eradication therapy was higher than that of control group(7.25% vs 4.20%; OR=1.62, 95%CI 1.20-2.19, P=0.002). Subgroup analysis found that Asian patients, 40 to 50 years old, follow-up time more than 1 year, and peptic ulcer had higher incidence of endoscopic reflux esophagitis; (2) The incidence of reflux symptoms was not significantly different between H. pylori eradication group and control group (25.2% vs 24.6%; OR=1.03, 95%CI 0.87-1.21, P=0.76). Further analysis indicated that reflux symptoms were not related to some relevant factors, such as races, age at diagnosis, follow-up time and underlying diseases. The eradication of H. pylori is considered as one of risk factors for GERD, especially in Asian populations, long time follow-up, 40 to 50 years old and patients with peptic ulcer. Meanwhile, the eradication of H. pylori does not suggest the correlation with reflux symptoms. H. pylori eradication therapy should be administrated according to patients' individual conditions.

Higher Frequency of Reflux Symptoms and Acid-Related Dyspepsia in Women than Men Regardless of Endoscopic Esophagitis: Analysis of 3,505 Japanese Subjects Undergoing Medical Health Checkups

Background/Aims: This study aimed at (i) clarifying the factors associated with high scores on the modified frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) among 3,505 relatively healthy subjects undergoing routine medical health checkups with gastrointestinal endoscopy and (ii) comparing risk factors for high FSSG scores between subjects with and without reflux esophagitis. Methods: In total, 3,505 subjects (male/female: 1,922/1,583) who underwent upper gastrointestinal endoscopy during health medical checkups at 5 hospitals in Saga, Japan from January 2013 to December 2013 were enrolled. All subjects completed a modified FSSG questionnaire, which comprised 7 questions regarding reflux symptoms and 7 questions regarding acid-related dyspepsia. Each question was assigned a score based on the frequency of symptoms. Results: Younger age, female gender, hiatal herniation, and endoscopic reflux esophagitis were risk factors for a FSSG score with a high total. Subjects with high scores but without esophagitis were women, and hiatal herniation and Barrett's esophagus were frequently seen in patients with reflux esophagitis. Conclusion: Younger age, female gender, hiatal hernia, and endoscopic esophagitis were risk factors for a high FSSG score, and women tended to complain of upper gastrointestinal symptoms more frequently than did men among subjects without endoscopic esophagitis.

The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children

Gastroesophageal reflux (GER) is the retrograde flow of gastric contents into the esophagus and may induce a variety of complications. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of GER independent of its acidity. The aim of this study is to investigate the GER patterns in children with the aid of MII-pH monitoring and determine the correlation between endoscopically proven reflux esophagitis and reflux types by MII-pH monitoring. One hundred and twenty children were enrolled from January 2010 to October 2011 for MII-pH monitoring. We studied the GER patterns by means of pH (acid and nonacid reflux) and composition (liquid, mixed, and gas reflux) by the esophageal MII-pH signals. Meanwhile, 34 (28.3%) patients received esophagogastroduodenoscopy examination at the same time. The severity of reflux esophagitis was graded with Los Angeles classification. MII-pH monitoring significantly increased the detection of numbers of reflux compared with traditional 24-hour pH monitoring (p<0.001). The significant cutoff value of MII-pH parameters including DeMeester score ≥ 21, duration of longest acid reflux ≥ 17minutes, and occurrence of acid reflux for more than 5minutes showed good correlation in the prediction of the presence of endoscopic reflux esophagitis. The odds ratios of the above mentioned parameters were 12.6, 8.94, and 7.5, respectively (p=0.02, p=0.01, and p=0.01). Furthermore, ≥ 3 episodes per day of acid reflux for more than 5minutes can predict the occurrence of severe reflux esophagitis (odds ratio 12.78, p=0.009). MII-pH monitoring not only raised the diagnostic yield in identifying GER, but it also showed significant correlation with the presence of endoscopically proven reflux esophagitis in children.

Functional Advantages of Proximal Gastrectomy with Jejunal Interposition Over Total Gastrectomy with Roux-en-Y Esophagojejunostomy for Early Gastric Cancer.

The postoperative functional advantages of a proximal gastrectomy over a total gastrectomy remain debatable. The aim of this study was to evaluate the functional outcomes of a proximal gastrectomy with jejunal interposition (PG-JI), compared with those for a total gastrectomy with Roux-en-Y esophagojejunostomy (TG-RY), in patients with early gastric cancer. Between 2007 and 2012, 65 patients underwent PG-JI and 117 underwent TG-RY for cT1 gastric cancer. Various parameters, including body weight, serum hemoglobin level, and interview-based symptoms, were prospectively evaluated in these patients. In patients who underwent PG-JI, the postoperative endoscopic findings were also assessed. All the surgeries were performed via a laparotomy alone. During a median postoperative follow-up of 42 months (range, 12-78 months), PG-JI offered significant reductions in body weight loss (12.5 ± 5.8 vs. 17.4 ± 6.4 %, P < 0.001), serum hemoglobin decline (7.0 ± 5.7 vs. 9.7 ± 5.4 %, P = 0.002), and dumping symptoms (11 % [7/65] vs. 30 % [35/117], P = 0.003), while being associated with similar incidences of anastomotic stricture (9 % [6/65] vs. 8 % [9/117], P = 0.781), small bowel obstruction (0 % [0/65] vs. 2 % [2/117], P = 0.538), stasis symptoms (51 % [33/65] vs. 44 % [51/117], P = 0.358), and reflux symptoms (34 % [22/65] vs. 23 % [27/117], P = 0.121), compared with TG-RY. Four cases of gastric remnant cancer and no cases of endoscopic reflux esophagitis were found after PG-JI. PG-JI has clear functional advantages over TG-RY, although it requires active surveillance for remnant gastric cancer.

500 The Induction of Pathological Acid Reflux With Acute Reflux Esophagitis in Humans Is Associated With T Lymphocyte-Predominant Inflammation of the Esophageal Mucosa: A New Paradigm for the Pathogenesis of Reflux Esophagitis

Introduction: Reflux esophagitis (RE) traditionally has been assumed to start when acid and pepsin destroy esophageal squamous cells at the luminal surface, inducing an acute, granulocyte-predominant inflammatory response. However, recent studies in animal RE models have challenged this traditional notion, suggesting that refluxed gastric juice does not destroy squamous cells directly, but instead stimulates them to secrete chemokines, which attract lymphocytes that mediate tissue damage. Patients typically have months to years of GERD symptoms before seeking medical attention, and so the early histologic changes of RE have not been evaluated prospectively in humans. To elucidate those changes, we induced acute RE by discontinuing PPIs in patients with healed RE. Methods: Patients with a prior endoscopy showing LA grade C RE were treated with PPIs BID for at least 1 month before a baseline endoscopy to document healing. PPIs then were stopped and endoscopy repeated 1 and 2 weeks later. At each endoscopy, 4 biopsies were taken from nonulcerated mucosa in the distal esophagus for histology and immunohistochemical staining for lymphocyte markers (CD3, CD20). Esophageal pH monitoring and GERD-HRQL symptom scoring were performed at baseline and 2 weeks. Biopsies were scored for type and degree of inflammation, for basal and papillary hyperplasia, and for spongiosis (dilated intercellular spaces) on a scale of 0 to 3. Results: 9 patients (8 men; mean age 67 years) had mean esophageal acid exposure (total % time pH<4) that increased from 6.6% at baseline to 28.4% at 2 weeks (p=.002), and mean GERD-HRQL scores that increased from 8.3 to 13.4 (p= .03). All patients developed endoscopic RE by 2 weeks (2 LA-A, 3 LA-B, 4 LA-C). Lymphocytes were by far the predominant type of inflammatory cell. Lymphocytes, basal and papillary hyperplasia, and spongiosis increased significantly from baseline to week 1, but not from week 1 to 2 (see Table). Lymphocytes were almost exclusively CD3+T cells, and found predominantly in peripapillary areas. There were few eosinophils in any biopsy at any time point. Neutrophils were also few in number and generally found only in association with micro-erosions at weeks 1 and 2; 4 of the 9 patients had no neutrophils in any biopsy at any time. Conclusions: In patients with severe RE healed by PPI therapy, stopping PPIs for 2 weeks causes a profound increase in acid reflux with acute RE that is characterized histologically by infiltration of the esophageal mucosa with T lymphocytes. Neutrophils and eosinophils do not appear to play an important role. The finding that acute RE in humans is a form of lymphocytic esophagitis supports the new paradigm for RE pathogenesis suggested by animal studies in which reflux does not destroy esophageal squamous cells directly, but rather stimulates them to secrete chemokines that attract lymphocytes.

Mo1120 Relatively High Prevalence of Endoscopic Reflux Esophagitis in Young Healthy Japanese Volunteers

Background/Aims Prevalence of reflux esophagitis have increased in Western and Eastern countries. The prevalence and disease-characteristics of endoscopic esophagitis in young Japanese individuals are not fully demonstrated. The aim of this study was to determine the prevalence of reflux esophagitis and Helicobacter pylori infection and their relationship in young healthy Japanese volunteers. Methods Upper gastrointestinal endoscopy was performed in 550 young healthy Japanese medical school students,age 21 to 36 years, mean 23.4 years,between 2008 and 2013. Helicobacter pylori infectionwas determined by detecting urinary IgG antibodies. Upper gastric clinical symptoms were monitored with questionnaires of FSSG scales. Results Helicobacter pylori antibodies were detected in 50 of the 550 subjects (9.09%) with endoscopic chronic gastritis without peptic ulcers. Endoscopic reflux esophagitis was detected in 55 out of the 550 subjects (10%), including grade A in 48 subjects (8.7%), grade B in 6 (1.09%) and grade C in 1 (0.18%). Only 5 subject with reflux esophagitis was Helicobacter pylori-positive, and the other 50 subjects with esophagitis were Helicobacter pylori-negative. Infection rate of Helicobacter pylori decreased around 40% during the last 6 years in a time dependent manner, although relatively high prevalence of reflux esophagitis of 10% was not changed during the last 6 year. Several factors were related to the prevalence of reflux esophagitis and most critical risk factors were lifestyles including alcohol consumption and increase in body weight. Clinical symptoms of heartburn were more common and FSSG scales were high in subjects with reflux esophagitis. FSSG scales were not different in subjects with or without Helicobacter pylori infection. Conclusion This study indicated relatively high prevalence (10%) of endoscopic reflux esophagitis in young Japanese adults around 23 years old, and risk factors for esophagitis were alcohol drinking and obesity.

Analysis on the clinical and endoscopic parameters in 1247 patients with reflux esophagitis

Aim: To summarize and analyze the clinical and endoscopic parameters in patients with reflux esophagitis(RE). Methods：1247 patients with RE were diagnosed in our hospital endoscopy center from September 2010 to August 2012. The general information of the patients and the relationship between endoscopic classification and concomitant diseases were analyzed. Results: According to the endoscopic findings, 1247 subjects (4.70%) were found to have RE：932 (74.74%) males and 315 (25.26%) females, and the male to female ratio was 2.96:1. The peak age of prevalence was 50 to 59 (27.35%) which is followed by 40 to 49 (23.10%). In this study, most of the patients had a mild degree of esophagitis representing LA-A in 60.63% and LA-B in 34.24%. The antrum hyperemia was found in 291 patients with esophagitis (23.34%), followed by antrum erosion (20.13%) and hatal hernia (15.88%). There is no statistically significant relevance between Helicobacter pylori infection and RE (P > 0.05), but Barrett’s esophagus, duodenal ulcer, gastroesophageal tumors, a history of gastroesophageal surgery and antrum hyperemia were found to be associated with RE (P . Conclusion: The prevalence rate of endoscopic RE in our study was 4.70%, and most patients had a mild grade esophagitis. Male, advanced age, Barrett’s esophagus, duodenal ulcer, gastroesophageal tumors and a history of gastroesophageal surgery are the risk factors of esophagitis. Antrum hyperemia may reduce the severity of RE.

Etiologies of Dyspepsia among a Chinese Population: One Hospital-Based Study

Background and Methods: Dyspepsia refers to a collection of upper gastrointestinal symptoms, and the causes may be either organic or functional. The aim of this study was to investigate the etiologies of dyspepsia among a Chinese population in Taiwan. Patients who underwent upper endoscopy for symptoms of dyspepsia were retrospectively analyzed between January and December 2008. Exclusion criteria included cirrhosis with varices, heart-burn sensation as the main symptom, gastrointestinal bleeding, hepatobiliary abnormalities, prior gastric surgery, and use of anti-acid medication for more than 2 months. Patients were classified according to the findings of upper endoscopy. Results: Data from the medical records of 2062 patients were collected and retrospectively analyzed. Normal endoscopic findings, gastritis, gastric ulcers, duodenal ulcers, reflux esophagitis and esophageal or gastric malignancy accounted for 1174 (56.9%), 215 (10.4%), 254 (12.3%), 194 (9.4%), 182 (8.8%) and 43 (2.1%) cases, respectively. The overall ratio of H. pylori infection was 28.4%. The ratio was the highest in duodenal ulcers and the lowest in reflux esophagitis. A significantly higher ratio of patients with gastric ulcers had a history of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) usage. Conclusion: Patients with organic dyspepsia, compared to those with functional dyspepsia, were older, male, and had a higher H. pylori infection ratio, a positive relationship with aspirin or NSAIDs usage, and more risk factors. These findings demonstrate that upper endoscopy has a high diagnostic yield in patients in this group.

Atypical Symptoms Are Related to Typical Symptoms Rather Than Histologic and Endoscopic Esophagitis

Atypical Symptoms Are Related to Typical Symptoms Rather Than Histologic and Endoscopic Esophagitis

Endoscopic Reflux Esophagitis and Helicobacter pylori Infection in Young Healthy Japanese Volunteers

Background/Aims: The prevalence of endoscopic esophagitis in young Japanese individuals is not fully apparent. The aim of this study was to determine the prevalence of reflux esophagitis (RE) and Helicobacter pylori infection and their relationship in young healthy Japanese volunteers. Methods: Upper gastrointestinal endoscopy was performed in 242 young healthy Japanese medical students (age range 22–29 years, mean 23.2 years) at Saga Medical School between 2008 and 2010. H. pylori infection was determined by detecting urinary IgG antibodies to H. pylori. Results:H. pylori antibodies were detected in 30 of the 242 subjects (12.4%). All 30 subjects had endoscopic chronic gastritis without peptic ulcers. Endoscopic RE was present in 27 of the 242 subjects (11.2%), corresponding to grade A in 19 subjects (7.9%), grade B in 7 (2.9%) and grade C in 1 (0.4%). Only 1 subject with RE was H. pylori-positive; the other 26 subjects with esophagitis were H. pylori-negative. We found no risk factors for H. pylori infection, but a risk factor for endoscopic esophagitis was alcohol consumption. Conclusion: The prevalence of H. pylori infection and endoscopic RE was 12.4 and 11.2%, respectively, in young healthy Japanese volunteers. Alcohol consumption was a risk factor for RE.