Predictive factors of silent reflux in subjects with erosive esophagitis.

BACKGROUND: Asymptomatic erosive esophagitis by definition is a condition lacking any reflux symptom. AIMS: We aimed to investigate the prevalence of asymptomatic erosive esophagitis in a general population undergoing periodic health checkup. METHODS: Consecutive subjects undergoing a medical checkup were enrolled for evaluation of reflux disease with upper endoscopy and a validated reflux questionnaire. The presence and severity of erosive esophagitis were evaluated. In all subjects, demographic characteristics and biochemical data were recorded, and sleep and psychological characteristics were assessed by means of self-administered Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. RESULTS: Of 2568 subjects eligible for this study, erosive esophagitis was found in 676 subjects (26.3%), in whom the proportions of asymptomatic and symptomatic erosive esophagitis were 59.2% (400 subjects) and 40.8% (276 subjects) respectively. At a univariate analysis, it was found that asymptomatic erosive esophagitis subjects were more frequently of female gender, of older age, with a lower level of education. They also showed less alcohol and tea consumption, less depression, less anxiety, lower serum level of triglyceride, and lower prevalence of metabolic syndrome. Multivariate analysis revealed that female sex (OR = 1.645, p = 0.0146) was a positive predictive factor for asymptomatic erosive esophagitis, whereas higher level of education (OR = 0.564, p = 0.044), higher Taiwanese Depression Questionnaire score (OR = 0.922, p < 0.001), and the presence of metabolic syndrome (OR = 0.625, p = 0.0379) were negative predictive factors. CONCLUSIONS: Asymptomatic erosive esophagitis is a common feature in otherwise healthy subjects and is independently associated with female gender, lower education level, less depression, and lower prevalence of metabolic syndrome.

Male sex, hiatus hernia, and Helicobacter pylori infection associated with asymptomatic erosive esophagitis.

BACKGROUND AND AIMS: Asymptomatic erosive esophagitis (AEE) is an easily forgotten subgroup of gastroesophageal reflux disease due to its lack of warning symptoms, despite having the risk of developing complications, such as bleeding, stricture, or even esophageal adenocarcinoma. METHODS: A total of 2843 potentially eligible patients were screened at the health management center of Buddhist Tzu Chi General Hospital. A total of 1001 patients responded to the survey and gave informed consent; 998 patients who completed the reflux disease diagnostic questionnaire were enrolled. Of them, 594 patients who had no reflux symptoms were included for final analysis. The presence and severity of erosive esophagitis was graded according to the Los Angeles classification. Active infection of Helicobacter pylori (H. pylori) was determined by the Campylo-like organism (CLO) test during endoscopies. RESULTS: A total of 14.5% (86/594) of asymptomatic patients had endoscopic findings of erosive esophagitis. In the univariate analysis, male sex and hiatus hernia were significantly associated with AEE. Positive CLO tests had a trend association. Based on the multivariate analysis, male sex (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.35-3.98), hiatus hernia (OR: 4.48, 95% CI: 2.35-89.17), and positive CLO test (OR: 0.57, 95% CI: 0.34-0.95) were associated with AEE, as compared to the healthy controls. CONCLUSIONS: AEE is not a rare condition, and constitutes 14.5% of the asymptomatic population. Male sex, hiatus hernia, and H. pylori infection are factors associated with AEE. These findings are not only helpful in identifying such asymptomatic patients, but also provide information to improve understanding of the relationship between H. pylori infection, reflux symptoms, and erosive esophagitis.

Increased incidence of gastroesophageal reflux disease in patients with chronic hepatitis B virus infection.

BACKGROUND: Although chronic liver disease is associated with gastroesophageal reflux disease (GERD), the impact of chronic hepatitis B virus (HBV) infection on this association remains unclear. We thus aimed to evaluate the relationship between chronic HBV infection and GERD. METHODS: In this prospective population-based study, 1,001 adult subjects who underwent an upper gastrointestinal endoscopic examination in a health check-up and completed a gastroesophageal reflux questionnaire were consecutively enrolled. Endoscopic findings were classified according to the Los Angeles classification. Hepatitis B surface antigen was used as a marker of HBV infection. Univariate and multivariate approaches were used to evaluate the effects of chronic HBV infection on GERD. RESULTS: Chronic HBV infection was associated with heartburn sensation [odds ratio (OR) 1.27, 95% confidence interval 1.01-1.61, P = 0.037], and erosive esophagitis (adjusted OR 1.75, 1.03-2.97, P = 0.037). Although male gender is a risk factor of erosive esophagitis, further analyses stratified by gender and aspartate aminotransferase to platelet ratio index (APRI) showed that chronic HBV infection was associated with erosive esophagitis in female subjects (adjusted OR 2.70, 1.14-6.39, P = 0.024) and those with APRI of more than 0.3 (adjusted OR 3.94, 1.73-8.96, P = 0.001). Moreover, higher serum aspartate aminotransferase (AST) and triglyceride (TG) levels were risk factors of erosive esophagitis in patients with chronic HBV infection. CONCLUSIONS: Our findings indicate a close association between chronic HBV infection and GERD, especially in female subjects and those with higher APRI levels. Moreover, HBV carriers with higher AST or TG levels have higher incidence of erosive esophagitis. The interactions between chronic HBV infection and GERD need further studies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12072-010-9184-4) contains supplementary material, which is available to authorized users.

Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy.

BACKGROUND: Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury. METHODS: Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded. OBSERVATIONS: All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff. CONCLUSIONS: EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.