Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia

Abstract

Background: Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD).

Aim: To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE.

Methods: We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05.

Results: The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively.

Conclusion: Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

Keywords: Erosive esophagitis; Esophagogastroduodenoscopy; Gastroesophageal reflux disease; Heart burn; Hiatal hernia.

Figure 1

Patient selection flow chart. LA: Los Angeles; TASH: Tikur Anbesa specialized hospital; AMSC: Adera medical and surgical center; GOO: Gastric outlet obstruction.

Figure 2

The dietary patterns of patients with erosive esophagitis at Tikur Anbesa specialized hospital and Adera medical and surgical center were reported during the study period.

Figure 3

Specific symptoms reported by patients with erosive esophagitis at Tikur Anbesa specialized hospital and Adera medical and surgical center during the study period.