Morbidity, mortality, and risk factors for esophagitis in hospital inpatients

Esophagitis is a common endoscopic finding, although its prevalence and con tribution to morbidity and mortality in hospital inpatients has not been sy stematically evaluated. This study aimed to determine the prevalence of eso phagitis among hospital inpatients referred for upper gastrointestinal endo scopy, to assess factors associated with the presence of esophagitis, and t o determine the mortality of patients with esophagitis. All inpatients refe rred for upper gastrointestinal endoscopy in a district general hospital we re assessed prospectively for one year. The reason for referral, endoscopy findings, and one-month mortality were determined together with a history o f nasogastric intubation, periods spent supine, and drug use. Of 595 inpati ents who underwent gastroscopy, -58% were referred for investigation of acu te upper gastrointestinal bleeding. Esophagitis was found in 196 (33%). Eso phagitis was significantly associated with wide-bore nasogastric intubation (p = 0.021; relative risk, 2.61; 95% CI, 0.64-6.06) but not with fine-bore nasogastric intubation. Esophagitis was also significantly associated with being nursed supine (p = 0.015; relative risk, 1.41; 95% CI, -1.75-6.72). There was no association between esophagitis and specific drug therapy. Mor tality among patients with esophagitis was higher than those without esopha gitis (p = 0.04; relative risk, 1.38; 95% CI, 0.34-3.22). Re flux esophagit is is common in hospital inpatients who are endoscoped. Although the underl ying diseases are likely to account for the high mortality, the association s of wide-bore nasogastric intubation and being nursed supine should alert caregivers to an increased risk. If nasogastric intubation is required for feeding only, fine-bore tubes should be considered.