Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study

• Published in: World journal of gastroenterology : WJG 2017-01, Vol.23 (2), p.318-327
• Main Authors: Sakaguchi, Masahiro, Manabe, Noriaki, Ueki, Nobuo, Miwa, Jun, Inaba, Tomoki, Yoshida, Norimasa, Sakurai, Kouichi, Nakagawa, Masahiro, Yamada, Hajime, Saito, Michiya, Nakada, Koji, Iwakiri, Katsuhiko, Joh, Takashi, Haruma, Ken
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking - adverse effects; Barrett Esophagus - epidemiology; Cross-Sectional Studies; Esophageal Diseases - epidemiology; Esophageal Diseases - etiology; Esophageal Stenosis - epidemiology; Esophageal Stenosis - etiology; Esophagitis, Peptic - complications; Esophagitis, Peptic - diagnostic imaging; Esophagitis, Peptic - drug therapy; Esophagoscopy; Female; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnostic imaging; Gastroesophageal Reflux - drug therapy; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Humans; Japan - epidemiology; Male; Middle Aged; Observational Study; Peptic Ulcer - complications; Peptic Ulcer - diagnostic imaging; Peptic Ulcer - epidemiology; Prospective Studies; Proton Pump Inhibitors - therapeutic use; Psychotropic Drugs - adverse effects; Psychotropic Drugs - therapeutic use; Risk Factors; Stress, Psychological - complications; Stress, Psychological - drug therapy
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i2.318

AIM To assess the clinical characteristics of patients with complicated erosive esophagitis(EE) and their associated factors.METHODS This prospective, cross-sectional study included patients diagnosed with EE by upper gastrointestinal endoscopy between October 2014 and March 2015 at 106 Japanese hospitals. Data on medical history, general condition, gastrointestinal symptoms, lifestyle habits, comorbidities, and endoscopic findings were collected using a standard form to create a dedicated database. Logistic regression analysis was used to calculate adjusted odds ratios(aO R) and 95%CI for the association with complicated EE.RESULTS During the study period, 1749 patients diagnosed with EE, 38.3% of whom were prescribed proton pump inhibitors(PPIs) were included. Of them, 143(8.2%) had EE complications. Esophageal bleeding occurred in 84(4.8%) patients, esophageal strictures in 45(2.6%) patients, and 14(0.8%) patients experienced both. Multivariate analysis showed that increased age(a OR: 1.05; 95%CI: 1.03-1.08), concomitant use of psychotropic agents(a OR: 6.51; 95%CI: 3.01-13.61), and Los Angeles grades B(a OR: 2.69; 95%CI: 1.48-4.96), C(aO R: 15.38; 95%CI: 8.62-28.37), and D(aO R: 71.49; 95%CI: 37.47-142.01) were significantly associated with complications, whereas alcohol consumption 2-4 d/wk was negatively associated(a OR: 0.23; 95%CI: 0.06-0.61). Analyzing associated factors with each EE complication separately showed esophageal ulcer bleeding were associated with increased age(a OR: 1.05; 95%CI: 1.02-1.07) and Los Angeles grades B(aO R: 3.60; 95%CI: 1.52-8.50), C(a OR: 27.61; 95%CI: 12.34-61.80), and D(a OR: 119.09; 95%CI: 51.15-277.29), while esophageal strictures were associated with increased age(a OR: 1.07; 95%CI: 1.04-1.10), gastroesophageal reflux symptom(aO R: 2.51; 95%CI: 1.39-4.51), concomitantuse of psychotropic agents(a OR: 11.79; 95%CI: 5.06-27.48), Los Angeles grades C(aO R: 7.35; 95%CI: 3.32-16.25), and D(a OR: 20.34; 95%CI: 8.36-49.53) and long-segment Barrett’s esophagus(a OR: 4.63; 95%CI: 1.64-13.05).CONCLUSION Aging and severe EE were common associated factors, although there were more associated factors in esophageal strictures than esophageal ulcer bleeding. Despite the availability and widespread use of PPIs, EE complications are likely to remain a problem in Japan owing to the aging population and high-stress society.