Background: Exposure to acid and duodeno-gastro-esophageal reflux(DGER) both increase with esophageal lesions in GORD. It is unknown whether DGER exposure is an independent risk factor for esophageal lesions. We performed a multivariate analysis on the relationship between esophageal lesions and demographics and acid and DGER exposure.
Methods: In 422 patients with suspected GORD, upper endoscopy, esophageal manometry and pH and DGER monitoring were performed. Stepwise logistic regression was used to identify factors associated with presence of oesophagitis, severity of oesophagitis and presence of Barrett's esophagus. Odds ratios(OR) and 95%confidence intervals (CI) were computed at different cut-offs.
Results 54% of the patients had no oesophagitis, 36% had grade A-B, 3% had grade C-D oesophagitis and 7% had Barrett's esophagus. In multivariate analysis, oesophagitis was associated with hiatal hernia (OR 3.621, 95%c.i. 2.263-5.794), and DGER exposure (OR up to 2.236, 95%c.i. 1.356-3.685), while a low BMI seemed protective (OR for BMI>1st quartile 2.245, 95%c.i. 1.371-3.677). Severity of oesophagitis was only associated with acid exposure (OR up to 5.038, 95%c.i. 1.452-17.480). The presence of Barrett's esophagus was associated with male sex (OR 3.621, 95%c.i. 2.263-5.794), DGER (OR up to 5.017, 95%c.i. 2.051-12.274) and acid exposure (OR up to 3.031, 95%c.i. 1.216-7.556).
Conclusions: Several independent factors are associated with esophageal lesions in GORD. The risk of oesophagitis is associated with hiatal hernia, BMI and DGER exposure; severity of oesophagitis depends on acid exposure and Barrett's esophagus is associated with male sex and exposure to both acid and DGER.