Risk factors for erosive reflux esophagitis: A case-control study

OBJECTIVES: It is presently not fully understood which risk factors contrib ute to the occurrence of reflux esophagitis and how such factors might infl uence the severity of the disease. The aim of this study was to delineate t he clinical epidemiology of erosive reflux esophagitis. METHODS: Outpatients from a medicine and gastroenterology clinic who underw ent upper GI endoscopy were recruited into a case-control study. A total of 1533 patients with and 3428 patients without endoscopically diagnosed refl ux esophagitis were categorized as case and control subjects, respectively. Using multivariate logistic regressions for statistical analysis, the pres ence of esophageal erosions, ulcers or strictures, served as three separate outcome variables. Demographic characteristics, intake of nonsteroidal ant i-inflammatory drugs (NSAIDs), consumption of alcohol and cigarettes, and t he presence of hiatus hernia or peptic ulcer served as predictor variables. RESULTS: Erosive reflux esophagitis tended to occur more frequently in Cauc asian male patients. Hiatus hernia was associated with a strong risk for de veloping esophageal erosions, ulcers, and strictures. Although statistical significance was demonstrated only for esophageal erosions, in all grades o f reflux esophagitis alike, gastric and duodenal ulcer exerted a protective influence. Consumption of NSAIDs increased the risk for esophageal ulcers only. Smoking and alcohol were nut associated with an increased risk of dev eloping any type of erosive reflux esophagitis. CONCLUSIONS: The results stress the critical role played by hiatus hernia i n all grades of erosive reflux esophagitis. NSAIDs may act through a mechan ism of topically induced esophageal injury. Our data also suggest that the presence of either gastric or duodenal ulcer exerts a protective influence against the development of reflux disease. (Am J Gastroenterol 2001;96:41-4 6. (C) 2001 by Am. Coll. of Gastroenterology).