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. 2022 Feb 28;28(8):853-867.
doi: 10.3748/wjg.v28.i8.853.

Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

Yoo Min Han  1 , Su Jin Chung  2 , Seokha Yoo  3 , Jong In Yang  1 , Ji Min Choi  1 , Jooyoung Lee  1 , Joo Sung Kim  4
Affiliations

Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

Yoo Min Han et al. World J Gastroenterol. .

Abstract

Background: Helicobacter pylori (H. pylori) infection is known to prevent the occurrence of gastroesophageal reflux disease (GERD) by inducing gastric mucosal atrophy. However, little is known about the relationship between atrophic gastritis (AG) and GERD.

Aim: To confirm the inverse correlation between AG and the occurrence and severity of GERD.

Methods: Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included. The grade of reflux esophagitis was evaluated according to the Los Angeles classification. Endoscopic AG (EAG) was categorized into six grades. Serologic AG (SAG) was defined as pepsinogen I ≤ 70 ng/mL and pepsinogen I/II ratio ≤ 3.0. The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.

Results: In total, 4684 individuals with GERD were compared with 21901 healthy controls. In multivariate logistic regression analysis, advanced age, male sex, body mass index > 23 kg/m2, presence of metabolic syndrome, current smoking, and alcohol consumption were associated with an increased risk of GERD. Seropositivity for H. pylori immunoglobulin G antibodies was associated with a decreased risk of GERD. There was an inverse correlation between the extent of EAG and occurrence of GERD: Odds ratio (OR), 1.01 [95% confidence interval (CI): 0.90-1.14] in C1, 0.87 (0.78-0.97) in C2, 0.71 (0.62-0.80) in C3, 0.52 (0.44-0.61) in O1, 0.37 (0.29-0.48) in O2, and 0.28 (0.18-0.43) in O3. Additionally, the extent of EAG showed an inverse correlation with the severity of GERD. The presence of SAG was correlated with a reduced risk of GERD (OR = 0.49, 95%CI: 0.28-0.87, P = 0.014).

Conclusion: The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD. AG followed by H. pylori infection may be independently protect against GERD.

Keywords: Atrophic gastritis; Gastroesophageal reflux disease; Helicobacter pylori; Pepsinogen; Reflux esophagitis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the study enrollment. GERD: Gastroesphageal reflux disease; GI: Gastrointestinal; NERD: Non-erosive reflux disease; PPI: Proton pump inhibitor; LA: Los Angeles.
Figure 2
Figure 2
Multivariate analysis on the risk for occurrence of gastroesphageal reflux disease according to the extent of endoscopic atrophic gastritis. 1Adjusted for age, sex, body mass index, metabolic syndrome, medication of sedatives or hypnotics, alcohol consumption, smoking history, physical activity, dietary factor, and Helicobacter pylori immunoglobulin G. CI: Confidence interval; GERD: Gastroesophageal reflux disease; OR: Odds ratio.
Figure 3
Figure 3
The grade of gastroesophageal reflux disease in relation to the extent of endoscopic atrophic gastritis. A: Prevalence of gastroesophageal reflux disease (GERD) according to the extent of endoscopic atrophic gastritis (EAG); B: Distribution of the severity of GERD according to the extent of EAG. NERD: Non-erosive reflux disease; LA: Los Angeles.
Figure 4
Figure 4
Impact of the extent of endoscopic atrophic gastritis on the risk for severity of gastroesophageal reflux disease. 1Adjusted for age, sex, body mass index, metabolic syndrome, medication of sedatives or hypnotics, alcohol consumption, smoking history, physical activity, dietary factor, and Helicobacter pylori immunoglobulin G. NERD: Non-erosive reflux disease; CI: Confidence interval; OR: Odds ratio; LA: Los Angeles.
Figure 5
Figure 5
Pepsinogen I, II and I/II ratio according to the severity of gastroesophageal reflux disease. a P < 0.0033 compared to normal; bP < 0.001 compared to non-erosive reflux disease. NERD: Non-erosive reflux disease; LA: Los Angeles.
Figure 6
Figure 6
Prevalence of gastroesophageal reflux disease according to serologic atrophic gastritis. NERD: Non-erosive reflux disease; LA: Los Angeles; SAG: Serologic atrophic gastritis.
Figure 7
Figure 7
Multivariate analysis on the risk for occurrence of gastroesophgeal reflux disease according to serologic atrophic gastritis. 1Adjusted for age, sex, body mass index, metabolic syndrome, medication of sedatives or hypnotics, alcohol consumption, smoking history, physical activity, dietary factor, and Helicobacter pylori immunoglobulin G Ab. NERD: Non-erosive reflux disease; CI: Confidence interval; SAG: Serologic atrophic gastritis; OR: Odds ratio.
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