Old Age and Male Sex and an Increased Risk of Esophagitis
Old Age and Male Sex and an Increased Risk of Esophagitis
Background and Aims: Silent gastroesophageal reflux disease (GERD) is often detected during routine screening esophagogastroduodenoscopy (EGD). However, the risk factors and clinical implications of silent GERD remain unclear. In the present study, we investigated the risk factors for asymptomatic erosive esophagitis by analyzing the local area health examination data.
Methods: The Korean National Health Insurance Corporation provides a bi-annual health examination performed by qualified local hospitals for the early detection of cancer in medical insurance holders over 40 years of age. Participants who completed self-reported questionnaires on health, followed by EGD at the Myongji Hospital (Goyang, Korea), were enrolled in this study.
Results: The data of a total of 5301 participants who underwent EGD between January 2005 and December 2008 were analyzed. The prevalence of erosive esophagitis was 6%. In the multivariate analysis, erosive esophagitis was strongly associated with an age greater than 60 years (odds ratio [OR]: 0.7, 95% confidence interval [CI]: 0.6–1.0), male sex (OR: 2.3, 95% CI: 1.7–3.0), hiatus hernia (OR: 2.9, 95% CI: 2.1–4.0), duodenal ulcer (OR: 1.6, 95% CI: 1.1–2.5), hypertension (OR: 1.5, 95% CI: 1.2–2.0), and smoking (OR: 1.4, 95% CI: 1.0–1.8). Of the 320 participants with erosive esophagitis, 145 (45.3%) were asymptomatic participants, and those who were more frequently greater than 60 years (OR: 1.8, 95% CI: 1.1–3.1) and male (OR: 1.8, 95% CI: 1.1–3.2).
Conclusions: Asymptomatic erosive esophagitis in adults older than 40 years is strongly associated with old age (≥ 60 years) and male sex compared with symptomatic erosive esophagitis.
Gastroesophageal reflux disease (GERD) is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. However, asymptomatic erosive esophagitis and asymptomatic Barrett's esophagus have often been found during upper endoscopy, and several studies have reported these types of GERD. These asymptomatic diseases were proposed as "silent GERD" by Fass and colleagues, which is defined as the presence of esophageal mucosal injury that is typical for GERD, but that is observed in individuals who lack typical or atypical esophageal manifestations of GERD. This concept of silent GERD caused Japanese researchers to divide GERD into the following three categories: traditional GERD, non-erosive GERD, and asymptomatic GERD.
The clinical implications and natural history of silent GERD are not yet fully understood. The important issue of silent GERD is that asymptomatic erosive esophagitis might progress to asymptomatic Barrett's esophagus, which might subsequently progress to esophageal adenocarcinoma. Several studies have shown that some portion of esophageal cancer is associated with no GERD symptoms.
The risk factors for conventional GERD are well known, and the management algorithm and preventive methods are well recognized. However, the risk factors for silent GERD remain unclear. The purpose of this study was to investigate the risk factors associated with asymptomatic erosive esophagitis to help differentiate silent GERD from conventional GERD.
Abstract and Introduction
Abstract
Background and Aims: Silent gastroesophageal reflux disease (GERD) is often detected during routine screening esophagogastroduodenoscopy (EGD). However, the risk factors and clinical implications of silent GERD remain unclear. In the present study, we investigated the risk factors for asymptomatic erosive esophagitis by analyzing the local area health examination data.
Methods: The Korean National Health Insurance Corporation provides a bi-annual health examination performed by qualified local hospitals for the early detection of cancer in medical insurance holders over 40 years of age. Participants who completed self-reported questionnaires on health, followed by EGD at the Myongji Hospital (Goyang, Korea), were enrolled in this study.
Results: The data of a total of 5301 participants who underwent EGD between January 2005 and December 2008 were analyzed. The prevalence of erosive esophagitis was 6%. In the multivariate analysis, erosive esophagitis was strongly associated with an age greater than 60 years (odds ratio [OR]: 0.7, 95% confidence interval [CI]: 0.6–1.0), male sex (OR: 2.3, 95% CI: 1.7–3.0), hiatus hernia (OR: 2.9, 95% CI: 2.1–4.0), duodenal ulcer (OR: 1.6, 95% CI: 1.1–2.5), hypertension (OR: 1.5, 95% CI: 1.2–2.0), and smoking (OR: 1.4, 95% CI: 1.0–1.8). Of the 320 participants with erosive esophagitis, 145 (45.3%) were asymptomatic participants, and those who were more frequently greater than 60 years (OR: 1.8, 95% CI: 1.1–3.1) and male (OR: 1.8, 95% CI: 1.1–3.2).
Conclusions: Asymptomatic erosive esophagitis in adults older than 40 years is strongly associated with old age (≥ 60 years) and male sex compared with symptomatic erosive esophagitis.
Introduction
Gastroesophageal reflux disease (GERD) is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. However, asymptomatic erosive esophagitis and asymptomatic Barrett's esophagus have often been found during upper endoscopy, and several studies have reported these types of GERD. These asymptomatic diseases were proposed as "silent GERD" by Fass and colleagues, which is defined as the presence of esophageal mucosal injury that is typical for GERD, but that is observed in individuals who lack typical or atypical esophageal manifestations of GERD. This concept of silent GERD caused Japanese researchers to divide GERD into the following three categories: traditional GERD, non-erosive GERD, and asymptomatic GERD.
The clinical implications and natural history of silent GERD are not yet fully understood. The important issue of silent GERD is that asymptomatic erosive esophagitis might progress to asymptomatic Barrett's esophagus, which might subsequently progress to esophageal adenocarcinoma. Several studies have shown that some portion of esophageal cancer is associated with no GERD symptoms.
The risk factors for conventional GERD are well known, and the management algorithm and preventive methods are well recognized. However, the risk factors for silent GERD remain unclear. The purpose of this study was to investigate the risk factors associated with asymptomatic erosive esophagitis to help differentiate silent GERD from conventional GERD.
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