Risk Factors for Erosive Esophagitis: A Multivariate Analysis Based on the ProGERD Study Initiative

Labenz, Joachim; Jaspersen, D; Kulig, Michael; Leodolter, Andreas; Lind, Tore; Meyer‐Sabellek, W.; Stolte, Manfred; Vieth, M; Willich, Stefan N.; Malfertheiner, Peter

doi:10.1111/j.1572-0241.2004.30390.x

Cited by 175 publications

(177 citation statements)

References 20 publications

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“…Th e ProGERD study, likely the largest of its kind ( > 5,000 patients) used logistic regression analysis to identify several independent risk factors for ERD. Th e odds for higher degrees of ERD increased as BMI rose ( 18 ). It is of greatest concern that there has been a well-documented association between BMI and carcinoma of the esophagus and gastric cardia ( 19 ).…”

Section: Symptoms and Epidemiologymentioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,529

1,430

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Section: Symptoms and Epidemiologymentioning

confidence: 99%

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Katz¹,

Gerson²,

Vela³

2013

American Journal of Gastroenterology

1,529

1,430

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“…4,6 Patients can progress from NERD to ERD, even on proton-pump inhibitor (PPI) therapy, but progression from ERD to BE is uncommon and from NERD to BE is very uncommon. [7][8][9] Labenz et al reported on the progression of GERD (ProGERD) study of 3,894 patients with GERD who underwent baseline endoscopy and repeat endoscopy at 2 years. 8 As is characteristic of a disease spectrum, many patients had progressed or regressed from one GERD stage to another.…”

Section: Introductionmentioning

confidence: 99%

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Lord

DeMeester

Peters

et al. 2009

Journal of Gastrointestinal Surgery

115

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Background and Aims Gastroesophageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux disease (ERD), and Barrett's esophagus (BE). Treatment outcomes for patients with different stages have differed in many studies. In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett's esophagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower esophageal sphincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication. Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified 50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esophagitis that was healed with acid suppression therapy, (3) severe ERD, defined as esophagitis that persisted despite medical therapy, and (4) BE. Exclusion criteria were normal distal esophageal acid exposure, esophageal pH monitoring performed elsewhere, antireflux surgery less than 1 year previously or previous fundoplication, and a named esophageal motility disorder or distal esophageal low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal esophageal pH monitoring; and were interviewed at least 1 year after operation. Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant preoperative symptom difference was that patients with BE had more moderately severe or severe dysphagia compared to patients with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and more esophageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients in all GERD categories. Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients.

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“…To the best of our knowledge, this is the first prospective population-based study to explore an association between chronic HBV infection and GERD. The increased incidence of GERD in HBV carriers was independent of other known risk factors [16][17][18]. Moreover, we found a differential association between genders and APRI levels, and chronic HBV infection was an independent risk factor of erosive esophagitis, especially in female subjects and Data are shown by mean ± standard deviation or proportion of the character P \ 0.05 is considered as statistical significance those with higher APRI levels.…”

Section: Discussionmentioning

confidence: 76%

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

et al. 2010

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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.

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Risk Factors for Erosive Esophagitis: A Multivariate Analysis Based on the ProGERD Study Initiative

Cited by 175 publications

References 20 publications

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

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

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