Clinical, Demographic, and Habit Characteristics of GERD Patients with and without Erosive Esophagitis

گوارش، مجله انجمن متخصصين گوارش و كبد ايران

دوره 15 - شماره Supple.1

Article Type: Original Article
Abstract: Introduction:Gastro-esophageal Reflux Disease (GERD) is a common, chronic, and relapsing disorder with increasing prevalence. GERD is classified as erosive (ERD) or non-erosive (NERD) according to endoscopic findings.We aimed to assess clinical, demographic, and habit differences between these two groups and assess risk factors for erosive esophagitis. Method: Patients with clinical GERD underwent upper GI endoscopy. All had at least one of the following symptoms for at least 4 weeks over the past 3 months: acid regurgitation (AR), heartburn (HB), dysphagia (D), or non cardiac chest pain (NCCP). Minor symptoms were also sought. A composite symptom score (SS) was calculated for each, considering frequency and severity of the major and minor symptoms. Educational level (illiterate, elementary school, high school, and university degree), age, smoking, tea drinking, and symptom duration were asked. Helicobacter Pylori (HP) infection was sought by rapid urease test (RUT) histologic examination. Univariate and multivariable analyses were done when appropriate. Results: Of the 700 cases (42% male, mean age: 39.2 yr), 374 (53%) had NERD. Mean age was similar between the 2 groups. Frequency of HB, AR, and D were not different between the 2 groups, however, NCCP (38.0% vs. 30.9%, p=0.05), epigastric pain (74.7%vs. 65.2%, p=0.008), and chronic interscapular pain (45.2% vs. 35.5, p=0.01) were more common among patients with NERD. Female gender, illiteracy, not smoking, absence of sliding hiatal hernia (SHH), HP positivity, no previous HP eradication, lower weight, and lower BMI were more prevalent among NERD patients (All P values < 0.05). Drinking tea was not different between the two groups. Although mean symptom duration was longer among patients with erosion but it did not reach statistical significance. No difference was found between the two groups regarding their symptom scores. Independent risk factors for erosive esophagitis were male gender (OR: 1.54, CI: 1.08-2.18, P=0.01), presence of sliding hiatal hernia (OR: 3.87, CI: 2.77-5.42, P< 0.001) and cigarette smoking (OR: 1.78, CI: 1.16-2.73, P: 0.008). Presence of HP protected against erosive esophagitis (OR: 0.61 CI: 0.44-0.85; P: 0.004). Conclusion: In comparison to ERD patients, NERD subjects are more expected to be female, non smoker, have lower weight and BMI, less educated and less likely to have received HP eradication. Absence of sliding hiatal hernia and being infected with HP is more commonly seen with NERD patients.Male sex, presence of SHH, and cigarette smoking are independent risk factors for erosive esophagitis and presence of HP seems to be protective. Painful symptoms (NCCP, epigastric pain and chronic interscapular pain) were more common among NERD patients which may point to different pathophysiologic mechanisms for NERD.