Incidence Of Erosive Esophagitis Research Articles

Gastrointestinal bleeding in children: diagnosis, analysis, and structure

The incidence of gastrointestinal bleeding is a significant concern among adult patients with gastrointestinal tract (GIT) disorders, as it is a leading cause of mortality. However, there is growing evidence of changes in the pattern of gastrointestinal pathologies among children, primarily attributed to an increasing number of cases related to peptic ulcer disease (PUD) and erosive processes of the GIT. Purpose - to investigate the prevalence and analyze changes in the structure of GIT diseases in children complicated by upper gastrointestinal bleeding (GIB), based on esophagogastroduodenoscopy (EGD) data. Materials and methods. Based on the clinic’s records, a total of 4,457 children underwent EGD at the Regional Medical Center of Family Health in Dnipro. Among them, 1,393 (31.25%) patients were admitted to the surgical department with suspected GIB. In 201 (14.4%) cases, EGD was performed during active bleeding to determine its origin. The utilization of EGD during the acute phase in patients with suspected GIB is considered highly effective for both diagnosing the bleeding source and initiating early-stage treatment. The data were processed using the methods of variation statistics using the Statistica v 6.1 software package. To compare the relative indicators, the Pearson Hi-quadrat test (χ2) and the two-sided Fisher’s exact test (TCF) were used. The critical level of statistical significance (p) was accepted as <0.05. Results. To conduct a comparative analysis of diagnosed cases of GIB, two groups of children with endoscopically confirmed GIB were formed: the Group I (n=125) representing the period of 2012-2013, and the Group II (n=201) - the period of 2020-2021. The results revealed an increase of 1.6 times in the number of patients with upper GIT diseases accompanied by bleeding in the Group II. Additionally, a significant rise in the frequency of GIT diseases, specifically erosive esophagitis, was observed. The number of patients with erosive esophagitis tripled in the Group II compared to the Group I. Conclusions. In recent years, there has been a notable rise in GIT diseases accompanied by upper GIB. The number of such cases increased by 1.6 times, from 125 to 201 patients. Notably, there is a pronounced increase in the incidence of erosive esophagitis, particularly among children in the early and younger age groups. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Association of Incidence of Acid-related Upper Gastrointestinal Disorders With Glycated Hemoglobin Level.

Previous cross-sectional studies show diabetes and higher levels of plasma hemoglobin A1c (HbA1c) are associated with a higher prevalence of gastrointestinal (GI) complications. However, whether the glycemic status is associated with incident acid-related upper GI disorders remains unclear. We aimed to determine the effect of hyperglycemia per se, in terms of HbA1c, on the incidence of acid-related disorders. We analyzed consecutive subjects who had undergone repeated upper endoscopies as part of the health examinations at the National Taiwan University Hospital from 2005 to 2011. Acid-related endoscopic abnormalities were defined as erosive esophagitis (EE), Barrett's esophagus (BE), and peptic ulcer disease (PUD), which included gastric ulcers (GUs) and duodenal ulcers (DUs). All subjects were categorized by 3 tertiles of HbA1c levels. We analyzed the occurrence of respective acid-related disorders during the follow-up period. A total of 11 391 participants (mean HbA1c level 5.6 ± 0.7%) were enrolled in this longitudinal study. During the 38 426.3 person-years of follow-up (mean duration 3.37 ± 1.59 years), the incidence of EE, BE, GU, DU, PUD, and any acid-related disorders were 22.1%, 0.5%, 4.5%, 8.6%, 12.3%, and 30.3%, respectively. The higher HbA1c level was associated with higher risk of disease incidents, except BE, during the follow-up (all log-rank P < .001). In the Cox regression analyses with confounding factors fully adjusted, the hazard ratios for EE, GU, DU, PUD, and acid-related disorders were 1.174, 1.339, 1.24, 1.24, and 1.186, respectively, for the third tertile of HbA1c (all P < .05). Higher HbA1c level was associated with a higher risk of acid-related upper GI endoscopic abnormalities. Efforts toward better glycemic control may help to prevent the development of late GI complications.

Predictors and timing for the development of symptomatic gastroesophageal reflux disease after successful Helicobactor pylori eradication therapy

Background Helicobacter pylori (H. pylori) eradication success increases the incidence of erosive esophagitis by normalization of gastric acid secretion. The aim of this study is to clarify predictors and timing for the development of symptomatic gastroesophageal reflux disease (GERD) after successful H. pylori eradication based on long-term follow-up. Methods From April 2014 to October 2020, 330 patients with H. pylori infections treated with a standard triple-drug regimen were enrolled, and their records retrospectively reviewed. Development of symptomatic GERD was defined as requiring proton pump inhibitor or vonoprazan therapy to treat symptoms. Results The mean follow-up period was 2.8 years, and symptomatic GERD developed in 41 (12%) patients during the study period. Overall rates of GERD-symptom free patients at 6 months, 1, and 2 years after eradication were 97%, 93%, and 89%, respectively. We evaluated predictors for the development of symptomatic GERD using a Cox proportional hazards regression model. In multivariate analysis, being a current smoker, having functional dyspepsia, hiatal hernia, and severe gastric atrophy were identified as significant predictive factors. The GERD domain score in the Izumo scale was significantly decreased 1 month after vonoprazan therapy consistent with effective treatment of symptomatic GERD. Conclusions The rate of development of symptomatic GERD after successful H. pylori eradication is low over long-term follow-up and is easily controlled by vonoprazan therapy. However, patients with smoking habits, functional dyspepsia, hiatal hernia, or severe gastric atrophy should be followed carefully after eradication.

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40\u201369-years subjects

BackgroundVisceral fat obesity can be defined quantitatively by abdominal computed tomography, however, the usefulness of measuring visceral fat area to assess the etiology of gastrointestinal reflux disease has not been fully elucidated.MethodsA total of 433 healthy subjects aged 40–69 years (234 men, 199 women) were included in the study. The relationship between obesity-related factors (total fat area, visceral fat area, subcutaneous fat area, waist circumference, and body mass index) and the incidence of reflux erosive esophagitis was investigated. Lifestyle factors and stomach conditions relevant to the onset of erosive esophagitis were also analyzed.ResultsThe prevalence of reflux erosive esophagitis was 27.2% (118/433; 106 men, 12 women). Visceral fat area was higher in subjects with erosive esophagitis than in those without (116.6 cm2 vs. 64.9 cm2, respectively). The incidence of erosive esophagitis was higher in subjects with visceral fat obesity (visceral fat area ≥ 100 cm2) than in those without (61.2% vs. 12.8%, respectively). Visceral fat obesity had the highest odds ratio (OR) among obesity-related factors. Multivariate analysis showed that visceral fat area was associated with the incidence of erosive esophagitis (OR = 2.18), indicating that it is an independent risk factor for erosive esophagitis. In addition, daily alcohol intake (OR = 1.54), gastric atrophy open type (OR = 0.29), and never-smoking history (OR = 0.49) were also independently associated with the development of erosive esophagitis.ConclusionsVisceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in subjects aged 40–69 years.

Impact of Gastric Bypass on Erosive Esophagitis and Barret's Esophagus.

The association between gastroesophageal reflux disease (GERD) and obesity is clearly defined. The incidence of erosive esophagitis (EE) and Barrett's esophagus (BE) are as high as 26 and 6%, respectively. Gastric bypass (GBP) is considered the gold standard for obese patients with GERD. Evidence about the impact of GBP on EE and BE is not yet clear but more inspiring every day. Obese patients operated by GBP with EE or BE were included for this study. Demographics, BMI, %EWL, and the evolution of EE and BE with pre and postoperative upper endoscopy were analyzed. In this study, 64 patients were included, 55 with EE and 9 with BE. The preoperative BMI was 44.29km/m2 ± 3.5 and the %EWL was 78.5 ± 5.8 in the first year postoperative. Preoperatively, EE was distributed as follows: A: 54.5% (30), B: 34.5% (19), C: 9% (5), D: 2% (1). BE findings were the following: short segment (SSBE): 45% (4) and long segment (LSBE): 55% (5). Postoperatively, 80% of the patients with EE resolved their condition, 11% improved, 7% had no changes, and 2% worsened. From the patients with SSBE, 75% resolved their condition and 40% with LSBE resolved their condition after 24months and no patient progressed to dysplasia. Patients with EE had a statistically significant resolution after GBP. BE was improved or even resolved in many patients without acquiring significance but also without progression. Long-term surveillance data is necessary to define the certain evolution of EE and BE after GBP.

Comparison of proton pump inhibitor and histamine-2 receptor antagonist in the prevention of recurrent peptic ulcers/erosions in long-term low-dose aspirin users: a retrospective cohort study.

Background. Proton pump inhibitor and histamine-2 receptor antagonist can prevent aspirin-related ulcers/erosions but few studies compare the efficacy of these two agents. Aims. We evaluated the efficacy of omeprazole and famotidine in preventing recurrent ulcers/erosions in low-dose aspirin users. Methods. The 24-week clinical outcomes of the patients using low-dose aspirin for cardiovascular protection with a history of ulcers/erosions and cotherapy of omeprazole or famotidine were retrospectively reviewed. The incidence of gastrointestinal symptoms, recurrent ulcers/erosions, erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was analyzed. Results. A total of 104 patients (famotidine group, 49 patients; omeprazole group, 55 patients) were evaluated. Famotidine group had more gastrointestinal symptoms episodes than omeprazole group (46.9% versus 23.6%, P = 0.01). Fifteen famotidine group patients and 5 omeprazole group patients had recurrent ulcers/erosions (30.6% versus 9.1%, P = 0.005). Lanza scale was significantly lower in omeprazole group than in famotidine group (1.2 ± 0.7 versus 1.7 ± 1.1, P = 0.008). Only 1 famotidine group patient had ulcer bleeding. The incidences of erosive esophagitis and thromboembolic events were comparable between both groups. Conclusions. Omeprazole was superior to famotidine with less gastrointestinal symptoms and recurrent ulcers/erosions in patients using 24-week low-dose aspirin. The risk of erosive esophagitis, gastrointestinal bleeding, and thromboembolic events was similar between both groups.

TWELVE CASES OF ACUTE ESOPHAGEAL MUCOSAL LESION

Background and Aims: The incidence of erosive esophagitis in emergent endoscopy for upper gastrointestinal bleeding is not rare but the clinical and endoscopic findings have not been fully investigated. The aim of the present study was to clarify features of acute esophagitis cases showing acute onset and severe endoscopic findings. Methods: We defined severe esophagitis that endoscopically showed circumferential diffuse mucosal lesion involving at least the entire lower third of the esophagus as acute esophageal mucosal lesion and investigated the clinical and endoscopic characteristics. Results: We experienced six cases of black or dark esophagitis and six cases of non-black esophagitis. Both groups showed common clinical features. Patients were predominantly males older than middle age. The presenting symptoms were upper gastrointestinal bleeding such as coffee-ground-like vomit, hematemesis or tarry stool. Seven cases had a history of taking non-steroidal anti-inflammatory drugs. Endoscopically, both types of case showed diffuse circumferential erosion in the lower esophagus, which continuously extended, and worsened towards the esophagogastric junction. All had esophageal sliding hernia and five cases had duodenal mucosal lesion. All cases rapidly improved with a proton pump inhibitor except one case. Conclusion: Black and non-black esophagitis was considered to belong to the same disease entity, acute esophageal mucosal lesion, which should be recognized as a differential diagnosis on emergency endoscopy for upper gastrointestinal bleeding.

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.

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

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.

TWELVE CASES OF ACUTE ESOPHAGEAL MUCOSAL LESION

Background and Aims: The incidence of erosive esophagitis in emergent endoscopy for upper gastrointestinal bleeding is not rare but the clinical and endoscopic findings have not been fully investigated. The aim of the present study was to clarify features of acute esophagitis cases showing acute onset and severe endoscopic findings.Methods: We defined severe esophagitis that endoscopically showed circumferential diffuse mucosal lesion involving at least the entire lower third of the esophagus as acute esophageal mucosal lesion and investigated the clinical and endoscopic characteristics.Results: We experienced six cases of black or dark esophagitis and six cases of non‐black esophagitis. Both groups showed common clinical features. Patients were predominantly males older than middle age. The presenting symptoms were upper gastrointestinal bleeding such as coffee‐ground‐like vomit, hematemesis or tarry stool. Seven cases had a history of taking non‐steroidal anti‐inflammatory drugs. Endoscopically, both types of case showed diffuse circumferential erosion in the lower esophagus, which continuously extended, and worsened towards the esophagogastric junction. All had esophageal sliding hernia and five cases had duodenal mucosal lesion. All cases rapidly improved with a proton pump inhibitor except one case.Conclusion: Black and non‐black esophagitis was considered to belong to the same disease entity, acute esophageal mucosal lesion, which should be recognized as a differential diagnosis on emergency endoscopy for upper gastrointestinal bleeding.

Endoscopic treatment of gastroesophageal reflux disease: Effect of gender on clinical outcome

Objective. Gender differences in gastroesophageal reflux disease have been reported. Higher frequency and severity of symptoms, lower esophageal acid exposure and lower incidence of reflux-related complications have been observed in women. The aim of this study was to determine whether there are any gender differences in clinical presentation, diagnostic evaluations and response to endoscopic therapy in patients with gastroesophageal reflux disease. Material methods. Patients with gastroesophageal reflux disease referred for endoscopic therapy were scored for typical (heartburn and regurgitation) and atypical (chest pain, cough, wheezing, and hoarseness) symptoms at baseline. Upper endoscopy, manometry and pH studies were performed for all patients. Endoscopic treatment consisted of placement of two to three sutures within 2 cm of the squamocolumnar junction. Reflux symptoms were re-scored after endoscopic treatment. Results. Ninety-five patients (37 M, 58 F, mean age 51 years) were included in the analysis. Male and female patients at baseline reported similar severity of typical reflux symptoms as well as comparable prevalence of atypical symptoms. Manometric findings were also comparable between the genders. Endoscopic and ambulatory pH studies revealed a higher incidence of erosive esophagitis and a trend towards higher acid exposures in male patients. The response to endoscopic therapy was similar for men and women. Conclusions. Apart from a higher incidence of erosive esophagitis in male patients, no major differences were found in endoscopic, manometric, esophageal acid exposure studies and clinical response to endoscopic therapy between the genders.

Incidence of erosive esophagitis in a long-term study of patients with H.pylori eradication for ulcer hemorrhage

Incidence of erosive esophagitis in a long-term study of patients with H.pylori eradication for ulcer hemorrhage