Differences in Clinical Characteristics between Patients with Endoscopy-Negative Reflux Disease and Erosive Esophagitis in Japan

Fujiwara, Yasuhiro; Higuchi, Kazuhide; Shiba, Masatsugu; Yamamori, Kazuki; Watanabe, Yoko; Sasaki, Eiji; Tominaga, Kazunari; Watanabe, Toshio; Oshitani, Nobuhide; Arakawa, Tetsuo
April 2005
American Journal of Gastroenterology;Apr2005, Vol. 100 Issue 4, p754
Academic Journal
OBJECTIVE: Helicobacter pyloriinfection and atrophic gastritis are inversely related to erosive esophagitis. Whether these factors affect the pathogenesis of endoscopy-negative reflux disease is not clear. We aimed to elucidate the differences in clinical characteristics between endoscopy-negative erosive disease and erosive esophagitis.METHODS: 253 subjects (89 with endoscopy-negative reflux disease and 164 with erosive esophagitis) were studied. Gastric atrophy was assessed by measurement of serum pepsinogen. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) of endoscopy-negative reflux disease compared with erosive esophagitis.RESULTS: Among GERD patients, female gender (OR= 2.27, 95% CI, 1.25–4.10), smoking (OR= 0.45, 95% CI, 0.22–0.91), and the presence of hiatal hernia (OR= 0.30, 95% CI, 0.17–0.56) were significantly associated with endoscopy-negative reflux disease compared with male gender, not smoking, and absence of hiatal hernia, respectively. Body mass index (BMI) was also significantly associated with a decreased OR for endoscopy-negative reflux disease. AlthoughH. pyloriinfection and gastric atrophy were significantly more common in patients with endoscopy-negative reflux disease, these associations did not persist in a multiple-adjustment model. After adjustment for gender, BMI, smoking, and hiatal hernia, a decrease in serum pepsinogen I/II ratio was significantly associated with an increased OR for endoscopy-negative reflux disease (pfor trend= 0.018).CONCLUSIONS: Female gender, low BMI, not smoking, absence of hiatal hernia, and severity of gastric atrophy were positively associated with endoscopy-negative reflux disease compared with erosive esophagitis among Japanese patients.(Am J Gastroenterol 2005;100:1-5)


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