Morbidity, mortality, and risk factors for esophagitis in hospital inpatients

Esophagitis is a common endoscopic finding, although its prevalence and contribution to morbidity and mortality in hospital inpatients has not been systematically evaluated. This study aimed to determine the prevalence of esophagitis among hospital inpatients referred for upper gastrointestinal endoscopy, to assess factors associated with the presence of esophagitis, and to determine the mortality of patients with esophagitis. All inpatients referred for upper gastrointestinal endoscopy in a district general hospital were assessed prospectively for one year. The reason for referral, endoscopy findings, and one-month mortality were determined together with a history of nasogastric intubation, periods spent supine, and drug use. Of 595 inpatients who underwent gastroscopy, 58% were referred for investigation of acute upper gastrointestinal bleeding. Esophagitis was found in 196 (33%). Esophagitis was significantly associated with wide-bore nasogastric intubation (p = 0.021; relative risk, 2.61; 95% CI, 0.64-6.06) but not with fine-bore nasogastric intubation. Esophagitis was also significantly associated with being nursed supine (p = 0.015; relative risk, 1.41; 95% CI, -1.75-6.72). There was no association between esophagitis and specific drug therapy. Mortality among patients with esophagitis was higher than those without esophagitis (p = 0.04; relative risk, 1.38; 95% CI, 0.34-3.22). Reflux esophagitis is common in hospital inpatients who are endoscoped. Although the underlying diseases are likely to account for the high mortality, the associations of wide-bore nasogastric intubation and being nursed supine should alert caregivers to an increased risk. If nasogastric intubation is required for feeding only, fine-bore tubes should be considered.