Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy

Abstract

Compared with findings in Western countries, the prevalence of reflux esophagitis in Oriental countries is estimated to be low. In this prospective study, we aimed to examine the proportion of reflux esophagitis in Japanese adults, as evaluated by endoscopy. Endoscopists were prospectively directed to grade esophageal mucosal breaks with esophagitis according to the Los Angeles Classification of Esophagitis in all subjects that underwent endoscopic examination. In total, 6010 subjects underwent endoscopic examination for evaluation of esophagitis grading from December 1996 to February 1998. The subjects included 4394 outpatients who were not receiving medication for gastrointestinal disease and 1616 subjects who visited the hospital for routine physical examinations. The overall proportion of esophagitis was 16.3%. Most of the subjects with esophagitis were classified as having grade A or B (proportion of grades A and B, 9.6% and 4.6%, respectively). The age-related proportion of esophagitis and of severe esophagitis (i.e., grades C and D) increased in females aged over 70 and in males aged over 80. Increased body mass index (partly due to decreased height caused by osteoporosis), and/or hiatal herniation, were related to the proportion of esophagitis in females aged over 70. These data indicated that reflux esophagitis is a common disease in Japan. However, severe esophagitis (grades C and D) is not common.

Gender Differences in the Time-Course Changes of Reflux Esophagitis in Japanese Patients

“…We are unable to explain the discrepancy in the chronological changes in the diaphragmatic hiatus and BMI observed in our female subjects, and further studies are needed to clarify the factors involved. Aging may have some role in increasing the size of the diaphragmatic hiatus in our study subjects, since an age-related increase in the incidence of hiatal hernia has been previously demonstrated in women (2,3).…”

“…GERD has been becoming more prevalent in Asian populations in recent decades, and although the disease is considered to be a common disorder in both Western and Asian populations, its increasing prevalence in Asia may be due to multiple factors, such as the Westernization of eating habits, decrease in the rate of Helicobacter pylori infection, increased gastric acid secretion and a larger elderly population, as well as other factors (2)(3)(4)(5)(6)(7)(8)(9). High intra-abdominal pressure caused by abdominal fat accumulation has been demonstrated to increase the gastroesophageal pressure gradient and incidence of gastroesophageal reflux, while obesity and a high body mass index (BMI) have repeatedly been reported to be correlated with a high prevalence of reflux esophagitis and symptoms of GERD (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Sex and Gender Differences in Gastroesophageal Reflux Disease

“…8,36 In a multicenter study performed in Korea in 2006 with 25 536 subjects who received esophagogastroduodenoscopic examination for medical check-up, the prevalence of reflux esophagitis was significantly higher in men (11.2%) than in women (3.1%) (P < 0.0001), 34 GERD symptoms* which was similar to the results in a 2011 nationwide multicenter study. 30 Moreover, the degree of esophagitis was more severe in males than in females. 34 However, the percentage of women having NERD (5%) was higher than that of men having NERD (3%).…”

“…9,[26][27][28][29][30][31][32][33][34][35][36][37][38] A meta-analysis has described that the men/women ratio in the prevalence of reflux esophagitis was 1.57 (95% CI, 1.40-1.76) and the mean age of men with reflux esophagitis was lower than that of women. 7 In a systematic review based on data of 67 056 patients using the PubMed database between 1997 and 2011 (including 12 unbiased population-based studies, 8 studies from Asian countries, 2 studies from Europe, and 1 study from the US), the prevalence of reflux esophagitis was lower in women compared to that men (women: 6.1 ± 1.6%, range: 2.1-16.8%; men: 15.9 ± 2.5%, range: 7.0-28.1%; P < 0.01).…”

“…29,30,37,52 Moreover, older women showed more severe reflux esophagitis than older men and the incidence of severe reflux esophagitis tends to be increased higher in postmenopausal women than in men. 29,30 Another endoscopy-based study has reported that the incidence of reflux esophagitis was increased in women after the age of 50 years. 29 The incidence of reflux esophagitis in women was similar to that in men by the age of 80 years.…”