Background and study aim: The aim of this study was to determine the prevalence, characteristics, and risk factors of erosive esophagitis and Barrett’s esophagus in an adult Chinese population without gastroesophageal reflux symptoms.
Patients and methods: Between March 2006 and February 2007, consecutive individuals aged between 18 and 75 years, who underwent routine upper endoscopy as part of their regular medical examination were recruited. Demographic and medical information were collected. Erosive esophagitis was defined endoscopically as visible breaks of the distal esophageal mucosa. Barrett’s esophagus was diagnosed endoscopically and confirmed histologically. ”Silent GERD“ was defined when erosive esophagitis and/or Barrett’s esophagus were present in an individual without reflux symptoms.
Results: Among the 2580 individuals included, erosive esophagitis and Barrett’s esophagus were found in 4.3 % (n = 110) and 1.0 % (n = 27), respectively. In individuals with erosive esophagitis and Barrett’s esophagus, 33.6 % and 40.7 %, respectively, were asymptomatic. Thus, the prevalence of erosive esophagitis and Barrett’s esophagus in individuals without GERS was 1.6 % and 0.5 %, respectively, giving an overall prevalence of silent GERD of 2.0 % (46 / 2270). Multivariate analysis identified that male sex (odds ratio [OR] = 2.87, 95 % confidence interval [CI] 1.24 – 6.66; P = 0.014), hiatus hernia (OR = 9.68, 95 %CI 5.00 – 17.95; P < 0.001), and alcohol consumption (OR = 3.17, 95 %CI 1.44 – 6.97; P = 0.004) were positively associated with erosive esophagitis, whereas Helicobacter pylori infection (OR = 0.37, 95 %CI 0.14 – 0.98; P = 0.046) was negatively associated with erosive esophagitis. Alcohol consumption (OR = 5.32, 95 %CI 1.55 – 13.33; P = 0.008) was positively associated with Barrett’s esophagus in asymptomatic individuals.
Conclusion: In this cohort of the adult Chinese population without reflux symptoms, the prevalence of erosive esophagitis and Barrett’s esophagus is 1.6 % and 0.5 %, respectively, with an overall prevalence of silent GERD of 2.0 %. Male sex, hiatus hernia, and alcohol consumption are positively associated with erosive esophagitis, whereas a negative association exists for H. pylori infection. Alcohol consumption is positively associated with Barrett’s esophagus.
References
-
1
Vakil N, van Zanten S V, Kahrilas P. et al .
Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.
Am J Gastroenterol.
2006;
101
1900-1920
-
2
Fass R, Dickman R.
Clinical consequences of silent gastroesophageal reflux disease.
.
2006;
8
195-201
-
3
Lehmann F S, Renner E L, Meyer-Wyss B. et al .
Helicobacter pylori and gastric erosions. Results of a prevalence study in asymptomatic volunteers.
Digestion.
2000;
62
82-86
-
4
Ronkainen J, Aro P, Storskrubb T. et al .
High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report.
Scand J Gastroenterol.
2005;
40
275-285
-
5
Ronkainen J, Aro P, Storskrubb T. et al .
Prevalence of Barrett’s esophagus in the general population: an endoscopic study.
Gastroenterology.
2005;
129
1825-1831
-
6
Ecclissato C, Carvalho A F, Ferraz J G. et al .
Prevalence of peptic lesions in asymptomatic, healthy volunteers.
Dig Liver Dis.
2001;
33
403-406
-
7
Fock K M, Talley N, Moayyedi P. et al .
Asia-Pacific Gastric Cancer Consensus Conference. Asia-Pacific consensus on the management of gastroesophageal reflux disease: update.
J Gastroenterol Hepatol.
2008;
23
8-22
-
8
Pan G Z, Xu G M, Ke M Y. et al .
Epidemiological study on symptomatic gastroesophageal reflux disease in China: Beijing and Shanghai.
Chin J Dig Dis.
2000;
1
2-8
-
9
Armstrong D, Bennett J R, Blum A L. et al .
The endoscopic assessment of esophagitis: a progress report on observer agreement.
Gastroenterology.
1996;
111
85-92
-
10
Sharma P, McQuaid K, Dent J. et al .
AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop.
Gastroenterology.
2004;
127
310-330
-
11
DeVault K R, Castell D O.. American College of Gastroenterology .
Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.
Am J Gastroenterol.
2005;
100
190-200
-
12
Wong B C, Wong W M, Wang W H. et al .
An evaluation of invasive and non-invasive tests for the diagnosis of Helicobacter pylori infection in Chinese – the best tests for routine clinical use and research purposes.
Aliment Pharmacol Ther.
2001;
15
505-511
-
13
Bytzer P.
Goals of therapy and guidelines for treatment success in symptomatic gastroesophageal reflux disease patients.
Am J Gastroenterol.
2003;
98(3 Suppl)
S31-S39
-
14
Lagergren J, Bergström R, Lindgren A, Nyrén O.
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
N Engl J Med.
1999;
340
825-831
-
15
Shaheen N, Ransohoff D F.
Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications.
JAMA.
2002;
287
1982-1986
-
16
Sampliner R E.
Practice Parameter Committee of the American College of Gastroenterology. Updated guidelines for the diagnosis, surveillance, and therapy of Barrett's esophagus.
Am J Gastroenterol.
2002;
97
1888-1895
-
17
Wang K K, Sampliner R E.
Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus.
Am J Gastroenterol.
2008;
103
788-797
-
18
Rosaida M S, Goh K L.
Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study.
Eur J Gastroenterol Hepatol.
2004;
16
495-501
-
19
Wong W M, Lam S K, Hui W M. et al .
Long-term prospective follow-up of endoscopic esophagitis in southern Chinese – prevalence and spectrum of the disease.
Aliment Pharmacol Ther.
2002;
16
2037-2042
-
20
Hongo M.
Review article: Barrett’s esophagus and carcinoma in Japan.
Aliment Pharmacol Ther.
2004;
20(Suppl 8)
50-54
-
21
Mahadeva S, Raman M C, Ford A C. et al .
Gastro-oesophageal reflux is more prevalent in Western dyspeptics: a prospective comparison of British and South-East Asian patients with dyspepsia.
Aliment Pharmacol Ther.
2005;
21
1483-1490
-
22
Zentilin P, Iiritano E, Vignale C. et al .
Helicobacter pylori infection is not involved in the pathogenesis of either erosive or non-erosive gastro-oesophageal reflux disease.
Aliment Pharmacol Ther.
2003;
17
1057-1064
-
23
Fallone C A, Barkun A N, Mayrand S. et al .
There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori.
Aliment Pharmacol Ther.
2004;
20
761-768
-
24
Moayyedi P, Bardhan C, Young L. et al .
Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease.
Gastroenterology.
2001;
121
1120-1126
-
25
Rajendra S, Ackroyd R, Robertson I K. et al .
Helicobacter pylori, ethnicity, and the gastroesophageal reflux disease spectrum: a study from the East.
.
2007;
12
177-183
-
26
Wu J C, Chan F K, Ching J Y. et al .
Effect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: a double blind, placebo controlled, randomised trial.
.
2004;
53
174-179
-
27
Malfertheiner P, Gerards C.
Helicobacter pylori infection and gastro-oesophageal reflux disease: coincidence or association?.
Baillieres Best Pract Res Clin Gastroenterol.
2000;
14
731-741
-
28
Chan C L, Facer P, Davis J B. et al .
Sensory fibres expressing capsaicin receptor TRPV1 in patients with rectal hypersensitivity and faecal urgency.
Lancet.
2003;
361
385-391
-
29
Matthews P J, Aziz Q, Facer P. et al .
Increased capsaicin receptor TRPV1 nerve fibres in the inflamed human oesophagus.
Eur J Gastroenterol Hepatol.
2004;
16
897-902
M. H. ChenMD
Division of Gastroenterology and Hepatology
The First Affiliated Hospital of Sun-Yat Sen University
Guangzhou 510080
P. R. China
Fax: +86-20-87332916
eMail: chenminhu@vip.163.com
