Abstract

This study aims to establish a noninvasive scoring system to predict the risk of erosive esophagitis (EE). From 2002 to 2009, a total of 34, 346 consecutive adults who underwent health check-ups and upper gastrointestinal endoscopy were retrospectively enrolled. Of the participants, 22, 892 in the earlier two-thirds period of examination were defined as the training set and the remaining 11, 454 as the validation set. EE was diagnosed by upper gastrointestinal endoscopy. Independent risk factors associated with EE were analyzed by multivariate analysis using a logistic regression model with the forward stepwise selection procedure in the training set. Subsequently, an EE risk scoring system was established and weighted by β coefficient. This risk scoring system was further validated in the validation set. In the training set, older age, male gender, higher body mass index, higher waist circumference, higher serum triglyceride, and lower high-density lipid cholesterol levels were independent risk factors for predicting EE. According to the β coefficient value of each independent risk factor, the total score ranging from 0 to 10 was established, and then low- (0–3), moderate- (4–6), and high-risk (7–10) groups were identified. In the validation set, the prevalence rates of EE in the low-, moderate-, and high-risk groups were 5.15%, 15.76% and 26.11%, respectively (p < 0.001). This simple noninvasive risk scoring system, including factors of age, gender, body mass index, waist circumference, triglyceride, and high-density lipid cholesterol, effectively predicted EE and stratified its incidence.

Abstract

Incomplete symptom resolution to proton pump inhibitor (PPI) therapy is a common problem in the treatment of gastroesophageal reflux disease (GERD). The aims of this study were (1) to examine the rate of incomplete symptom response following 8-week PPI therapy in patients with mild erosive esophagitis (Los Angeles Grade A/B erosive esophagitis) and (2) to determine the independent factors predicting incomplete symptom response in patients with mild erosive esophagitis. From January 2010 to July 2012, symptomatic GERD patients with endoscopic findings of Los Angeles Grade A or B erosive esophagitis were recruited for the study and received esomeprazole 40 mg daily for 8 weeks. The characteristics of eligible patients including clinical factors, endoscopic findings, Helicobacter pylori status, and CYP2C19 (cytochrome P450 2C19) genotype were checked on enrollment. Patients were asked to record symptoms with diary cards during the follow-up period. The major outcome measurement was incomplete symptom response. In total, 232 patients (male/female, 126/106) participated in this study. Following 8-week esomeprazole therapy, 50 (21.6%) of the patients had incomplete symptom response. Univariate analysis showed that sex, alcohol consumption, underlying diseases, regurgitation of food, chest pain, globus, and insomnia were associated with incomplete symptom response (p = 0.049, p = 0.006, p = 0.023, p = 0.010, p = 0.013, p = 0.009, and p < 0.001, respectively). Multivariate analysis with stepwise logistic regression revealed that only globus [95% confidence interval (CI): 1.185–4.897, p = 0.015] and insomnia (95% CI: 1.289–3.018, p = 0.002) were independent risk factors for incomplete symptom response with odds ratio (OR) = 2.4 and OR = 2.0, respectively. Of the patients with Los Angeles Grade A/B erosive esophagitis, 21.6% failed to have complete symptom resolution following 8-week PPI therapy. Globus and insomnia are two independent factors predicting incomplete symptom response in patients with mild erosive esophagitis.