Risk factors for erosive esophagitis and Barrett's esophagus in a high Helicobacter pylori prevalence area

Abstract

Objective: To establish the prevalence and risk factors of erosive esophagitis (EE) and Barrett's esophagus (BE) among patients routinely referred for upper endoscopy.

Material and methods: A total of 4032 consecutive patients referred to a regional hospital for upper endoscopy due to upper gastrointestinal and/or "alarm" symptoms were examined. Analysis was performed on the prospectively selected patients (40 in each group) with EE of different grades and BE.

Results: EE was diagnosed in 474 patients (11.75%): grade A, in 194 (41%); grade B, in 167 (35%); grade C, in 65 (14%); and grade D, in 48 patients (10%). Increasing severity of erosive esophagitis and presence of its complication--Barrett's esophagus--were associated with the decreasing prevalence of H. pylori and increasing hiatal hernia size (P<0.05). Male gender (OR, 3.57; 95% CI, 1.12 to 10.62), hiatal hernia >2 cm (OR, 3.73; 95% CI, 1.60 to 8.68), and absence of H. pylori (OR, 4.24; 95% CI, 1.07 to 16.84) were the factors found to be associated with severe EE. The factors associated with BE were as follows: ulcer and/or stricture of esophagus (OR, 11.94; 95% CI, 2.51 to 41.37), age >60 years (OR, 1.06; 95% CI, 1.01 to 1.20), smoking >10 cigarettes per day (OR, 4.62; 95% CI, 1.01 to 12.50), hiatal hernia >2 cm (OR, 5.22; 95% CI, 1.86 to 14.64), and absence of H. pylori (OR, 5.60; 95% CI, 1.38 to 22.72).

Conclusions: The prevalence of EE was found to be low, and the prevalence of BE was found to be very low among routinely endoscoped patients in primary and secondary care settings in a Lithuanian rural area with high H. pylori prevalence. Increasing severity of gastroesophageal reflux disease was associated with the decreasing prevalence of Helicobacter pylori.