Background factors of reflux esophagitis and non-erosive reflux disease: a cross-sectional study of 10,837 subjects in Japan.
Background factors of reflux esophagitis and non-erosive reflux disease: a cross-sectional study of 10,837 subjects in Japan.
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回流食管炎和非疏松反流疾病的背景因素：日本10,837名受试者的横断面研究。
DOI：
10.1371/journal.pone.0069891
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Koike K
中科院分区：
文献类型：
--
作者：
Minatsuki C;Yamamichi N;Shimamoto T;Kakimoto H;Takahashi Y;Fujishiro M;Sakaguchi Y;Nakayama C;Konno-Shimizu M;Matsuda R;Mochizuki S;Asada-Hirayama I;Tsuji Y;Kodashima S;Ono S;Niimi K;Mitsushima T;Koike K
尽管胃食道反流病(GERD)的发病率很高，但其危险因素仍然是一个有争议的话题。这可能是由于对反流性食管炎(RE)和非糜烂性反流病(NERD)的区别不够充分，也可能是因为对邻近胃的评估不充分。因此，我们的目的是在评估幽门螺杆菌感染和胃萎缩的基础上，独立地确定RE和NERD的背景因素。我们分析了10,837名健康的日本人(6,332名男性和4,505名女性，年龄在20-87岁)，他们接受了上消化道内窥镜检查。在没有RE的受试者中，RE被诊断为存在粘膜破裂，NERD被诊断为存在烧心和/或反酸。以无GERD的受试者为对照，分别对RE和NERD的背景因素进行Logistic回归分析，计算标准化系数(SC)、优势比(OR)和p值。在10837名研究对象中，我们诊断出733人(6.8%)为RE，1722人(15.9%)为书呆子。对于RE，男性(SC = 0.557，或 = 1.75)，HP未感染(SC = 0.552，或 = 1.74)，较高的胃蛋白酶原I/II比率(SC = 0.496，或 = 1.64)，较高的体重指数(SC = 0.464，或 = 1.60)，饮酒(SC = 0.161，或 = 1.17)，年龄较大(SC = 0.148，或 = 1.16)，吸烟(SC = 0.129，OR = 1.14)是正相关因素。NERD、Hp感染(SC = 0.106或 = 1.11)、女性(SC = 0.099或 = 1.10)、较年轻(SC = 0.099或 = 1.10)、较高的胃蛋白酶原I/II比率(SC = 0.099或 = 1.10)、吸烟(SC = 0.080或 = 1.08)、较高的体重指数(SC = 0.078或 = 1.08)、饮酒(SC = 0.076，或 = 1.08)是正相关因素。慢性Hp感染者和成功根除Hp的患者RE发生率差异有统计学意义(2.3%和8.8%；p<；0.0001)，而NERD患者的RE患病率差异无统计学意义(18.2%和20.8%；p = 0.064)。NERD的相关因素与RE显著不同，说明这两种疾病在病理生理上是截然不同的。根除幽门螺杆菌可能对RE有不利影响，但对NERD无不良影响。
Despite the high prevalence of gastroesophageal reflux disease (GERD), its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE) and non-erosive reflux disease (NERD), and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy. We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20–87 years) who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC), odds ratio (OR), and p-value. Of the 10,837 study subjects, we diagnosed 733 (6.8%) as RE and 1,722 (15.9%) as NERD. For RE, male gender (SC = 0.557, OR = 1.75), HP non-infection (SC = 0.552, OR = 1.74), higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64), higher BMI (SC = 0.464, OR = 1.60), alcohol drinking (SC = 0.161, OR = 1.17), older age (SC = 0.148, OR = 1.16), and smoking (SC = 0.129, OR = 1.14) are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11), female gender (SC = 0.099, OR = 1.10), younger age (SC = 0.099, OR = 1.10), higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10), smoking (SC = 0.080, OR = 1.08), higher BMI (SC = 0.078, OR = 1.08), and alcohol drinking (SC = 0.076, OR = 1.08) are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001), whereas that of NERD shows no difference (18.2% and 20.8%; p = 0.064). Significantly associated factors of NERD are considerably different from those of RE, indicating that these two disorders are pathophysiologically distinct. Eradication of Helicobacter pylori may have disadvantageous effects on RE but not on NERD.
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