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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2017; 23(2): 318-327
Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.318
Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study
Masahiro Sakaguchi, Noriaki Manabe, Nobuo Ueki, Jun Miwa, Tomoki Inaba, Norimasa Yoshida, Kouichi Sakurai, Masahiro Nakagawa, Hajime Yamada, Michiya Saito, Koji Nakada, Katsuhiko Iwakiri, Takashi Joh, Ken Haruma
Masahiro Sakaguchi, Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan
Noriaki Manabe, Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama 701-0192, Japan
Nobuo Ueki, Department of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
Jun Miwa, Department of Gastroenterology, Toshiba General Hospital, Tokyo 140-8522, Japan
Tomoki Inaba, Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
Norimasa Yoshida, Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan
Kouichi Sakurai, Hattori Clinic, Kumamoto 860-0004, Japan
Masahiro Nakagawa, Department of Endoscopy, Hiroshima City Hospital, Hiroshima 730-8518, Japan
Hajime Yamada, Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe 651-0072, Japan
Michiya Saito, Michiya Clinic, Fukushima 971-8124, Japan
Koji Nakada, Department of Laboratory Medicine, Daisan Hospital Jikei University School of Medicine, Tokyo 201-8601, Japan
Katsuhiko Iwakiri, Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan
Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi 467-8601, Japan
Ken Haruma, Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama 700-8505, Japan
Author contributions: Manabe N and Haruma K designed research; Sakaguchi M, Manabe N, Ueki N, Miwa J, Inaba T, Yoshida N, Sakurai K, Nakagawa M, Yamada H, Saito M, Nakada K, Iwakiri K, Joh T and Haruma K performed research; Manabe N and Haruma K contributed new reagents or analytic tools; Manabe N and Haruma K analyzed data; Sakaguchi M and Manabe N wrote the paper.
Supported by An Investigator Sponsored Study Programme of AstraZeneca. The authors alone are responsible for the content and writing of the manuscript.
Institutional review board statement: This study was reviewed and approved by the ethics committee of each center and of Kawasaki Medical School, Kurashiki, Japan (Study Number: 1883).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Noriaki Manabe, MD, PhD, Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan.
n_manabe@hkg.odn.ne.jp
Telephone: +81-86-4621111 Fax: +81-86-4621199
Received: September 20, 2016
Peer-review started: September 21, 2016
First decision: October 20, 2016
Revised: October 29, 2016
Accepted: November 16, 2016
Article in press: November 16, 2016
Published online: January 14, 2017
Processing time: 114 Days and 3.6 Hours
AIM
To assess the clinical characteristics of patients with complicated erosive esophagitis (EE) and their associated factors.
METHODS
This prospective, cross-sectional study included patients diagnosed with EE by upper gastrointestinal endoscopy between October 2014 and March 2015 at 106 Japanese hospitals. Data on medical history, general condition, gastrointestinal symptoms, lifestyle habits, comorbidities, and endoscopic findings were collected using a standard form to create a dedicated database. Logistic regression analysis was used to calculate adjusted odds ratios (aOR) and 95%CI for the association with complicated EE.
RESULTS
During the study period, 1749 patients diagnosed with EE, 38.3% of whom were prescribed proton pump inhibitors (PPIs) were included. Of them, 143 (8.2%) had EE complications. Esophageal bleeding occurred in 84 (4.8%) patients, esophageal strictures in 45 (2.6%) patients, and 14 (0.8%) patients experienced both. Multivariate analysis showed that increased age (aOR: 1.05; 95%CI: 1.03-1.08), concomitant use of psychotropic agents (aOR: 6.51; 95%CI: 3.01-13.61), and Los Angeles grades B (aOR: 2.69; 95%CI: 1.48-4.96), C (aOR: 15.38; 95%CI: 8.62-28.37), and D (aOR: 71.49; 95%CI: 37.47-142.01) were significantly associated with complications, whereas alcohol consumption 2-4 d/wk was negatively associated (aOR: 0.23; 95%CI: 0.06-0.61). Analyzing associated factors with each EE complication separately showed esophageal ulcer bleeding were associated with increased age (aOR: 1.05; 95%CI: 1.02-1.07) and Los Angeles grades B (aOR: 3.60; 95%CI: 1.52-8.50), C (aOR: 27.61; 95%CI: 12.34-61.80), and D (aOR: 119.09; 95%CI: 51.15-277.29), while esophageal strictures were associated with increased age (aOR: 1.07; 95%CI: 1.04-1.10), gastroesophageal reflux symptom (aOR: 2.51; 95%CI: 1.39-4.51), concomitant use of psychotropic agents (aOR: 11.79; 95%CI: 5.06-27.48), Los Angeles grades C (aOR: 7.35; 95%CI: 3.32-16.25), and D (aOR: 20.34; 95%CI: 8.36-49.53) and long-segment Barrett’s esophagus (aOR: 4.63; 95%CI: 1.64-13.05).
CONCLUSION
Aging and severe EE were common associated factors, although there were more associated factors in esophageal strictures than esophageal ulcer bleeding. Despite the availability and widespread use of PPIs, EE complications are likely to remain a problem in Japan owing to the aging population and high-stress society.
Core tip: This nationwide prospective survey in Japan evaluated the clinical characteristics of complicated erosive esophagitis (EE) and its associated factors at the time of proton pump inhibitors (PPIs) availability in real-world clinical settings. Our results indicate that aging and severe EE were common associated factors, although there were more associated factors in esophageal strictures than esophageal ulcer bleeding, indicating that pathophysiology of esophageal strictures was more complex than esophageal ulcer bleeding. Despite the availability and widespread use of PPIs, EE complications are likely to remain a problem in Japan owing to the aging population and high-stress society.
