Risk factors of asymptomatic erosive esophagitis

doi:10.16138/j.1673-6087.2021.03.010

Abstract

Abstract:

Objective To explore the prevalence, risk factors, prognosis, and management of asymptomatic erosive esophagitis(AEE). Methods A total of 5 184 asymptomatic individuals who underwent gastroscopy for routine health checkup were included in our study. 475 (9.2%) patients with EE devoid of gastroesophageal reflux disease(GERD) symptoms were selected as AEE group. A total of 950 age- and gender-matched subjects with negative endoscopic findings were selected as healthy control group. The clinical data between the two groups were compared. The independent risk factors, prognosis, and treatment of AEE were analyzed. Results A higher body mass index (BMI) [odds ratio（OR）=1.101, P=0.001], fatty liver（OR=1.635, P=0.013）, hiatus hernia（OR=2.302, P=0.039）, and higher gamma-glutamyl transferase (GGT)(OR=1.008, P=0.013) were independent risk factors for AEE. A total of 140 patients were followed up after they were diagnosed with AEE. Regardless of treatment, improved esophagitis occurred in about 2/3 AEE patients（82.4% vs 65.3%）. However, the proportion of subjects with improved esophagitis was much higher in the proton pump inhibitor(PPI) treatment group than that in the non-treatment group. Conclusions Higher BMI, fatty liver, hiatus hernia, and higher GGT are independent risk factors for AEE. The prognosis of AEE is good and PPI treatment could improve AEE.

Key words: Gastroesophageal reflux disease, Hiatus hernia, Gastroscopy, Proton pump inhibitor

CLC Number:

R571

SUN Chao, YAO Weiyan, HUANG Jia, ZHU Ying, TANG Yuming. Risk factors of asymptomatic erosive esophagitis[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(03): 188-192.

Figures/Tables 5

临床特点	对照组 (n=950）	AEE组 (n=475)	t/χ²	P
年龄(岁)	51.63±0.30	51.63±0.43	-0.012	0.963
男性[n(%)]	790(83.2)	395(83.2)	0
BMI（kg/m²）	23.01±0.10	23.95±0.15	5.177	0.001
食管裂孔疝[n(%)]	63(6.6)	62（13.1）	2.526	<0.001
C反应蛋白(mg/L)	1.6±0.2	1.4±0.08	0.741	0.045
白细胞计数(×10⁹/L)	6.11±0.07	6.16±0.09	-0.434	0.669
红细胞计数(×10¹²/L)	4.87±0.02	4.94±0.03	-1.987	0.091
血红蛋白(g/L)	148.03±0.57	150.18±0.80	-2.222	0.031
血小板(×10⁹/L)	208.05±2.17	207.81±3.15	0.065	0.866
糖化血红蛋白(%)	5.62±0.03	5.75±0.05	2.526	0.003
空腹血糖(mmol/L)	5.52±0.04	5.60±0.06	1.172	0.242
胰岛素抵抗(mmol·mU/L²)	2.24±0.11	2.84±0.19	3.251	0.001
前白蛋白(mg/L)	288.02±2.04	288.32±2.99	0.035	0.696
谷丙转氨酶(U/L)	28.36±0.70	28.95±1.01	0.406	0.534
谷草转氨酶(U/L)	24.56±0.41	24.25±0.46	-0.666	0.800
碱性磷酸酶(U/L)	67.67±0.70	69.06±1.05	1.434	0.252
GGT(U/L)	35.69±1.39	44.27±3.01	3.007	0.034
总胆红素(μmol/L)	15.62±0.23	15.54±0.35	-0.512	0.678
直接胆红素(μmol/L)	2.562±0.04	2.515±0.05	-0.699	0.692
总蛋白(g/L)	72.45±0.17	72.33±0.21	-0.694	0.938
白蛋白(g/L)	44.80±0.12	44.75±0.16	-0.107	0.694
总胆汁酸(μmol/L)	3.50±0.11	3.99±0.28	1.527	0.823
血尿素氮(mmol/L)	5.31±0.05	5.21±0.06	-1.576	0.306
肌酐(μmol/L)	80.16±0.51	80.42±0.78	0.522	0.935
尿酸(μmol/L)	344.70±2.94	356.32±4.19	2.243	0.041
三酰甘油(mmol/L)	1.82±0.06	1.85±0.07	0.165	0.192
总胆固醇(mmol/L)	5.12±0.04	5.13±0.05	0.247	0.940
高密度脂蛋白(mmol/L)	1.30±0.01	1.30±0.02	-0.836	0.298
低密度脂蛋白(mmol/L)	3.17±0.03	3.17±0.04	0.338	0.873
游离脂肪酸(mmol/L)	0.49±0.01	0.52±0.02	1.240	0.237
游离三碘甲状腺原氨酸(pmol/L)	4.48±0.02	4.44±0.04	-0.903	0.183
游离甲状腺素(pmol/L)	13.36±0.07	13.22±0.15	-2.951	0.010
促甲状腺素(mU/L)	1.95±0.13	1.85±0.09	1.263	0.310
甲状腺球蛋白抗体 (U/mL)	9.51±2.14	7.69±3.53	-0.467	0.132
甲状腺过氧化物酶抗体 (U/mL)	12.65±3.55	16.27±6.40	-0.440	0.456
幽门螺杆菌感染(n/N)	128/509	68/306	0.175	0.551
病理	72/276	43/182	0.353	0.552
¹³C呼气试验	16/63	13/34	1.737	0.188
幽门螺杆菌抗体	40/170	12/90	3.824	0.051
影像学(n/N)
脂肪肝	191/429	137/244	8.414	0.004
胆结石	30/429	11/244	3.087	0.195
胆囊息肉	17/429	9/244	0.031	0.859
肾结石	13/429	9/244	0.213	0.644

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变量	P	OR	95%CI
脂肪肝	0.013	1.495	1.089~2.052
BMI	0.001	1.093	1.056~1.131
GGT	0.006	1.004	1.001~1.008
尿酸	0.022	1.004	1.000~1.004
胰岛素抵抗	0.007	1.233	1.060~1.434
糖化血红蛋白	0.021	1.275	1.038~1.566
血红蛋白	0.027	1.012	1.001~1.023
食管裂孔疝	<0.001	2.114	1.461~3.059

指标	PPI治疗组(n=68)	非治疗组(n=72)
进展	2(2.9)	7(9.7)
分级不变	10(14.7)	18(25.0)
改善	56(82.4)	47(65.3)