High prevalence of reflux esophagitis among upper endoscopies in Chinese patients with chronic liver diseases

Abstract

BackgroundReflux esophagitis (RE) is increasing in prevalence in China. There are very few studies on the prevalence and factors related to RE in patients with chronic liver diseases. The aims of this study were to determine the prevalence of RE by endoscopy in patients with chronic liver diseases and the possible related predictors of RE.MethodsA total of 1,280 patients with chronic liver disease and 29 patients with acute hepatitis A or E were prospectively evaluated. There were 879 and 401 patients with liver cirrhosis or chronic hepatitis, respectively. RE was classified by endoscopy according to the Los Angeles classification scheme.ResultsRE was diagnosed in 36.4% (469/1280) of the chronic liver disease patients, which was significantly higher than in the acute hepatitis patients (10.3% [3/29], P < 0.001). RE accounted for 43.0%, 9.7%, and 60.2% of patients with liver cirrhosis, chronic hepatitis(mild and medium), and liver failure, respectively. A high prevalence of RE existed in patients with liver failure and/or Child B and C liver cirrhosis, with typical symptoms of RE in 21.3% of the patients (100/469). There was a significant relationship between gender, age, ascites, and RE.ConclusionsThe high prevalence of RE among upper endoscopies of patients with severe chronic liver disease was demonstrated. Asymptomatic RE was more common in cirrhotic and liver failure patients. The role of RE in variceal bleeding, however, needs to be demonstrated.

Prevalence of Reflux Oesphagitis in Egyptian Patients With Liver Cirrhosis

“…In the present study, RE was more prevalent in the older patients with CLD (61%) above 60 years old. This agreed with Li et al (2010) who found a relationship between high RE prevalence among patients with chronic liver disease and ages. This agreed with Collen et al (1995) and Huang et al (1999) who found more severe gastroesophageal reflux and esophageal lesions in elderly patients as compared to younger ones.…”

“…In the present study, RE was more prevalent in males than in females (80.5% vs. 19.5%) with significant difference. This agreed with Li et al (2010) who found that RE was more in males than females. A more progressive clinical course and a predominance of cirrhosis with comorbid related factors contributing to RE like esophageal varices and ascites by Yu et al (2001) showed its' commonest in males.…”

Nonalcoholic fatty liver disease vs. obesity on the risk of erosive oesophagitis

“…In contrast, the risk factors of EE in the elderly group were smoking, coffee drinking and hiatal hernia [4]. Several other studies have suggested that EE is associated with male sex, hiatal hernia, lifestyle, chronic liver disease, general obesity, central obesity and metabolic syndrome [5][6][7][8].…”

Deleterious effect of proton pump inhibitors on the disease course of cirrhosis

“…It is possible that these patients have higher incidence of gastroesophageal reflux (GERD), which causes symptoms, or that doctors use PPIs for prophylactic reasons. Previous studies postulated that ascites accumulation in patients with cirrhosis may result in GERD [8]. Large and endoscopically treated varices may alter the esophageal motility and disturb the esophageal sphincter function, which might also provoke GERD [9,10].…”