Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study

Abstract

AIMTo assess the clinical characteristics of patients with complicated erosive esophagitis (EE) and their associated factors.METHODSThis prospective, cross-sectional study included patients diagnosed with EE by upper gastrointestinal endoscopy between October 2014 and March 2015 at 106 Japanese hospitals. Data on medical history, general condition, gastrointestinal symptoms, lifestyle habits, comorbidities, and endoscopic findings were collected using a standard form to create a dedicated database. Logistic regression analysis was used to calculate adjusted odds ratios (aOR) and 95%CI for the association with complicated EE.RESULTSDuring the study period, 1749 patients diagnosed with EE, 38.3% of whom were prescribed proton pump inhibitors (PPIs) were included. Of them, 143 (8.2%) had EE complications. Esophageal bleeding occurred in 84 (4.8%) patients, esophageal strictures in 45 (2.6%) patients, and 14 (0.8%) patients experienced both. Multivariate analysis showed that increased age (aOR: 1.05; 95%CI: 1.03-1.08), concomitant use of psychotropic agents (aOR: 6.51; 95%CI: 3.01-13.61), and Los Angeles grades B (aOR: 2.69; 95%CI: 1.48-4.96), C (aOR: 15.38; 95%CI: 8.62-28.37), and D (aOR: 71.49; 95%CI: 37.47-142.01) were significantly associated with complications, whereas alcohol consumption 2-4 d/wk was negatively associated (aOR: 0.23; 95%CI: 0.06-0.61). Analyzing associated factors with each EE complication separately showed esophageal ulcer bleeding were associated with increased age (aOR: 1.05; 95%CI: 1.02-1.07) and Los Angeles grades B (aOR: 3.60; 95%CI: 1.52-8.50), C (aOR: 27.61; 95%CI: 12.34-61.80), and D (aOR: 119.09; 95%CI: 51.15-277.29), while esophageal strictures were associated with increased age (aOR: 1.07; 95%CI: 1.04-1.10), gastroesophageal reflux symptom (aOR: 2.51; 95%CI: 1.39-4.51), concomitant use of psychotropic agents (aOR: 11.79; 95%CI: 5.06-27.48), Los Angeles grades C (aOR: 7.35; 95%CI: 3.32-16.25), and D (aOR: 20.34; 95%CI: 8.36-49.53) and long-segment Barrett’s esophagus (aOR: 4.63; 95%CI: 1.64-13.05).CONCLUSIONAging and severe EE were common associated factors, although there were more associated factors in esophageal strictures than esophageal ulcer bleeding. Despite the availability and widespread use of PPIs, EE complications are likely to remain a problem in Japan owing to the aging population and high-stress society.

Genotype Distribution and Molecular Epidemiology of Hepatitis C Virus in Guangzhou, China: Predominance of Genotype 1b and Increasing Incidence of Genotype 6a

“…Different genotypes have shown distinct geographic distribution patterns. In general, genotypes 1, 2, and 3 are prevalent worldwide, while genotypes 4 and 5 are primarily restricted to Africa and genotype 6 is endemic to Southeast Asia [1, 3, 5, 6]. However, such patterns are constantly evolving as a result of speedy transmission via global travel.…”

“…Among them, subtype 1b is predominant nationwide, accounting for approximately 75% of all HCV infections, followed by 2a [5, 10, 11]. However, little is known about the distribution pattern of HCV genotypes in Guangzhou, the capital of Guangdong province, China (Fig.…”

“…Although six genotypes (genotypes 1 to 6) and a number of subtypes have been detected in China, over 95% of these isolates belong to five major subtypes: 1b, 2a, 3a, 3b, and 6a [5, 7-11]. Among them, subtype 1b is predominant nationwide, accounting for approximately 75% of all HCV infections, followed by 2a [5, 10, 11].…”

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

“…A certain proportion of patients presenting to hospital with a history of GERD symptoms has severe ERD 5,10‐11 . If these patients do not receive PPI treatment with sufficient strength and duration, the mucosal injury may not heal fully and may lead to complications such as esophageal bleeding and stenosis 4,5,12 .…”

“…The Japanese clinical practice guidelines for GERD allow proton pump inhibitor (PPI) therapy to be administered as the initial treatment, without performing endoscopy, in patients presenting with GERD symptoms 1 . As a certain proportion of patients have severe erosive reflux disease (ERD), classified as grade C or D according to the endoscopic grading of GERD severity, 2,3 reducing PPI treatment on the basis of satisfactory relief in GERD symptoms at a comparatively early period is a matter of grave concern as it may lead to inadequate healing of mucosal injury, which could result in serious complications such as esophageal hemorrhage and stenosis 4,5 . Therefore, we examined the characteristics of the clinical features and therapeutic response of GERD symptoms to PPI therapy in patients with severe ERD.…”