Factors Predictive of Erosive versus Nonerosive Esophageal Reflux Disease

Introduction

Gastroesophageal reflux disease (GERD) is a common condition with a prevalence of 15–25% in the Western countries. The most common manifestations of GERD are erosive esophagitis (EE) or nonerosive esophagitis disease (NERD). While endoscopic evidence of EE is highly specific for GERD (90–90%), it is relatively insensitive (50%). In the subgroup of patients who have NERD, pH monitoring to assess for pathologic reflux can be very helpful. In these patients, a positive pH test can have a sensitivity of 60% with a specificity ranging from 85% to 90%.

Abstract

BACKGROUND

To date, studies are lacking to determine risk factors for erosive esophagitis versus nonerosive disease. This is important as erosive esophagitis can lead to complications such as bleeding and strictures. Our aim was to identify factors associated with the presence or absence of esophageal erosions in a large group of US patients presenting with gastroesophageal reflux disease symptoms.

METHODS

We reviewed the records of outpatients who underwent endoscopy for symptoms of chronic gastroesophageal reflux. We included patients who had a negative exam if they had a subsequent BRAVO capsule pH study off proton pump inhibitor (PPI) therapy. Results were imputed into an ordinal logistic regression model.

RESULTS

There were 429 patients, with 235 (54.8%) females. The mean age was 51.1±16.1 years. In the final ordinal logistic regression model, smoking OR = 5.23 (95% CI, 2.27–12.06); diabetes 4.95 (95% CI, 2.07–11.88); male gender 2.81 (95% CI, 1.61–4.92); and Black race 5.41 (95% CI, 1.41–20.66) were significantly associated with more severe reflux. The model appeared to be well calibrated; all 23 patients who were Black males that smoked and had diabetes were found to have endoscopic evidence of esophagitis.

CONCLUSIONS

Our study demonstrates that male gender, Black race, smoking, and the presence of diabetes are significantly associated with the presence of erosive esophagitis. We could not identify increasing body mass index as an independent predictor. Our results provide gastroenterologists with useful information as the patient profiles of those more likely to harbor erosions can be used to triage patients for endoscopy.

Keywords

Obesity, smoking, gastroesophageal reflux disease, diabetes, race