Prevalence of erosive esophagitis and Barrett’s esophagus in the adult Chinese population

 

 Buy Article Permissions and Reprints

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
  CrossrefPubMedGoogle Scholar
• 2 Fass R, Dickman R. Clinical consequences of silent gastroesophageal reflux disease.  . 2006;  8 195-201
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 15 Shaheen N, Ransohoff D F. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications.  JAMA. 2002;  287 1982-1986
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 20 Hongo M. Review article: Barrett’s esophagus and carcinoma in Japan.  Aliment Pharmacol Ther. 2004;  20(Suppl 8) 50-54
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar

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