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Risk factors for erosive reflux esophagitis: a case-control study
B Avidan1, A Sonnenberg, T G Schnell
1Department of Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
The American Journal of Gastroenterology
|February 24, 2001
Summary
Hiatus hernia is a major risk factor for erosive reflux esophagitis. Interestingly, gastric or duodenal ulcers appear protective against this condition, while NSAIDs may increase ulcer risk.
Area of Science:
- Gastroenterology
- Epidemiology
Background:
- The risk factors and disease severity determinants for reflux esophagitis remain incompletely understood.
- Clinical epidemiology of erosive reflux esophagitis requires further delineation.
Purpose of the Study:
- To identify and analyze the clinical epidemiology of erosive reflux esophagitis.
- To investigate risk factors influencing the occurrence and severity of reflux esophagitis.
Main Methods:
- A case-control study involving 1,533 patients with reflux esophagitis (cases) and 3,428 controls without.
- Upper GI endoscopy was used for diagnosis.
- Multivariate logistic regression analyzed demographic factors, NSAID use, alcohol, smoking, hiatus hernia, and peptic ulcer disease as predictors for esophageal erosions, ulcers, or strictures.
Main Results:
- Erosive reflux esophagitis was more common in Caucasian males.
- Hiatus hernia significantly increased the risk for esophageal erosions, ulcers, and strictures.
- Gastric and duodenal ulcers showed a protective effect against reflux esophagitis, while NSAID use was linked to an increased risk of esophageal ulcers only. Smoking and alcohol consumption were not associated with increased risk.
Conclusions:
- Hiatus hernia plays a critical role in all grades of erosive reflux esophagitis.
- NSAIDs might contribute to esophageal injury through topical mechanisms.
- The presence of gastric or duodenal ulcers appears to protect against the development of reflux disease.