The Prevalence and Associated Factors of Reflux Esophagitis During the COVID-19 Pandemic: A Retrospective Endoscopic Study in Japan

Objective The COVID-19 pandemic has significantly impacted the lifestyle patterns in Japan. During behavioral restrictions, reduced physical activity may have increased the prevalence of reflux esophagitis (RE). We compared the prevalence of RE regardless of the presence or absence of reflux symptoms before and during the pandemic and evaluated its relationship with clinical factors. Methods We conducted a retrospective analysis of individuals who underwent esophagogastroduodenoscopy during an annual health checkup. The study period was divided into pre-pandemic (April 2017-March 2020; 15,039 cases) and pandemic (April 2020-March 2023; 14,338 cases) phases. We compared the acid-suppressive agent use, the prevalence and severity of RE, BMI, waist circumference, and diaphragmatic hiatus size between the phases. Results The use of acid-suppressive agents increased from 4.6% before the pandemic to 6.3% during the pandemic (p <0.001). After excluding participants who used acid-suppressive agents, the prevalence of RE increased significantly from 14.3% before the pandemic to 18.9% during the pandemic (p <0.001), and the prevalence of severe RE cases increased from 0.6% to 1.4%. The diaphragmatic hiatus size increased significantly during the pandemic. The COVID-19 pandemic period was positively associated with RE, with an odds ratio (95% confidence interval) of 1.22 (1.14-1.31) in the multiple logistic regression analysis. Among the 4,440 individuals who underwent endoscopy in both phases without acid-suppressive agents, the RE prevalence, mean BMI, proportion with BMI ≥25 kg/m², and waist circumference increased significantly. Conclusion During the COVID-19 pandemic, the use of acid-suppressive agents and the prevalence of endoscopically diagnosed RE increased, which may be associated with an increased BMI, waist circumference, and diaphragmatic hiatus size, thus indicating the contribution of lifestyle-related factors.