Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis

Nguyen, Anh D.; Spechler, Stuart J.; Shuler, Monique; Souza, Rhonda F.; Dunbar, Kerry B.

doi:10.1097/mcg.0000000000000870

Cited by 9 publications

(12 citation statements)

References 16 publications

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“…The diagnosis of esophagitis in our endoscopy database reflected a heterogeneous population of inpatients and outpatients, which recent reports suggest may have distinct disease pathogenesis [ 10 ]. We therefore evaluated characteristics of outpatients and inpatients separately.…”

Section: Resultssupporting

confidence: 93%

“…To our knowledge, this is one of a few cohort studies examining risks for esophagitis severity in a predominantly Hispanic population of a large safety-net hospital that included similar numbers of males and females. Previous studies examining complications of gastroesophageal reflux disease have been skewed toward males and/or did not have significant Hispanic representation [ 5 , 10 ]. Multivariable logistic regression stratified by gender identified gender-specific risks in this unique population.…”

Section: Discussionmentioning

confidence: 99%

“…Although a previous study has reported the association of lower BMI with more severe esophagitis, the population consisted predominantly of White and African American males, with the majority of cases of severe esophagitis made in hospitalized patients [ 10 ]. Our patient population was predominantly Hispanic, included similar numbers of males and females, with similar number of cases of severe esophagitis in outpatients and inpatients.…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed inpatient hospitalization was associated with an increased OR for severe esophagitis in males only. This finding is consistent with previous reports [ 10 ] although it is not clear why inpatient status was not associated with an increased OR of severe esophagitis in females.…”

Section: Discussionmentioning

confidence: 99%

“…Male gender [3,4], Caucasian ethnicity [3][4][5], and obesity [3,4,6,7] have previously been identified as risk factors for severe esophagitis (Los Angeles classification Grades C, D). However, reports about the role of obesity and its association with GERD and its complications have been contradictory [6,[8][9][10][11]. Further, the applicability of reported risk factors for severe esophagitis in the vulnerable population served by a safety-net hospital or in the burgeoning Hispanic population is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Gender-Specific Risk Factors for Reflux Esophagitis in a Predominantly Hispanic Population of a Large Safety-Net Hospital

et al. 2020

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Background Defining factors associated with severe reflux esophagitis allows for identification of subgroups most at risk for complications of strictures and esophageal malignancy. We hypothesized there might be unique clinical features in patients with reflux esophagitis in a predominantly Hispanic population of a large, safety-net hospital. Aim Define clinical and endoscopic features of reflux esophagitis in a predominantly Hispanic population of a large, safetynet hospital. Methods This is retrospective comparative study of outpatients and hospitalized patients identified with mild (Los Angeles Grade A/B) and severe (Los Angeles Grade C/D) esophagitis through an endoscopy database review. The electronic medical record was reviewed for demographic and clinical data. Results Reflux esophagitis was identified in 382/5925 individuals: 56.5% males and 79.8% Hispanic. Multivariable logistic regression model adjusted for age, gender, race, body mass index (BMI), tobacco and alcohol use, and hospitalization status with severity as the outcome showed an interaction between gender and BMI (p ≤ 0.01). Stratification by gender showed that obese females had decreased odds of severe esophagitis compared to normal BMI females (OR = 0.18, 95% CI = 0.07-0.47; p < 0.01). In males, the odds of esophagitis were higher in inpatient status (OR = 2.84, 95% CI = 1.52 − 5.28; p < 0.01) and as age increased (OR = 1.37, 95% CI = 1.03 − 1.83; p = 0.03). Conclusions We identify gender-specific associations with severe esophagitis in a predominantly Hispanic cohort. In females, obese BMI appears to be protective against severe esophagitis compared to normal BMI, while in men inpatient status and increasing age were associated with increased odds of severe esophagitis.

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Section: Resultssupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gender-Specific Risk Factors for Reflux Esophagitis in a Predominantly Hispanic Population of a Large Safety-Net Hospital

et al. 2020

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A systematic review with meta‐analysis: Efficacy and safety of potassium‐competitive acid blocker compared with proton pump inhibitor in the maintenance of healed erosive esophagitis

Simadibrata,

Lesmana,

Pratama

et al. 2024

JGH Open

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IntroductionProton pump inhibitor (PPI) is the mainstay therapy for the maintenance of healed erosive esophagitis (EE). It is unknown whether potassium‐competitive acid blockers (PCABs) are more efficacious and safer than PPIs.MethodsOnly randomized controlled trials (RCTs) comparing PCABs to PPIs in the maintenance of healing rates of endoscopically proven healed EE and indexed in MEDLINE, EMBASE, and CENTRAL until 3 February 2024, were included. A fixed‐effects model meta‐analysis was performed to pool primary efficacy outcome (maintenance of healing rates at week 24) and safety data (any treatment‐emergent adverse event or TEAE). The risk of bias was assessed using Cochrane's Risk of Bias 2 (RoB2) tool.ResultsFour RCTs with a total of 2554 patients were eligible for inclusion. All trials were of low risk of bias. Compared to lansoprazole 15 mg, the maintenance rates of healed EE at week 24 were significantly higher with vonoprazan 10 mg (RR 1.13; 95% CI 1.07–1.19) and vonoprazan 20 mg (RR 1.15; 95% CI 1.10–1.21). Likewise, compared to lansoprazole 15 mg, any TEAEs were significantly greater with vonoprazan 20 mg (RR 1.10; 95% CI 1.01–1.20) but not vonoprazan 10 mg.ConclusionVonoprazan 10 and 20 mg were superior to lansoprazole 15 mg in the maintenance of the healing of EE. Any TEAEs were greater with vonoprazan 20 mg.

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Severe Upper Gastrointestinal Hemorrhage Caused by Reflux Esophagitis

et al. 2021

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Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis

Cited by 9 publications

References 16 publications

Gender-Specific Risk Factors for Reflux Esophagitis in a Predominantly Hispanic Population of a Large Safety-Net Hospital

Gender-Specific Risk Factors for Reflux Esophagitis in a Predominantly Hispanic Population of a Large Safety-Net Hospital

A systematic review with meta‐analysis: Efficacy and safety of potassium‐competitive acid blocker compared with proton pump inhibitor in the maintenance of healed erosive esophagitis

Severe Upper Gastrointestinal Hemorrhage Caused by Reflux Esophagitis

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