BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.
Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/complications/epidemiology/*pathology ; Duodenal Ulcer/complications/epidemiology/pathology ; Esophagoscopy ; Female ; Gastroesophageal Reflux/complications/epidemiology/pathology ; Hospitals ; Humans ; Male ; Metaplasia/complications/epidemiology/*pathology ; Middle Aged ; Prevalence ; Secondary Care ; Stomach Ulcer/complications/epidemiology/pathology

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.
*Endoscopy, Gastrointestinal ; Esophageal Sphincter, Lower ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/epidemiology/*pathology ; Hernia, Hiatal ; Humans ; Korea/epidemiology ; Male ; Manometry/instrumentation ; Middle Aged ; Prevalence ; Prospective Studies

BACKGROUND: Reflux esophagitis is inversely associated with the presence of atrophic gastritis, and endoscopic grading of atrophic gastritis correlates with histological evaluation. The aim of this study was to investigate the association of the endoscopic grade of atrophic gastritis with gastroesophageal and gastropharyngeal reflux. METHDOS: A total of 627 patients, who underwent endoscopy and ambulatory 24-hour dual-probe pH monitoring, were included in this study. The grade of atrophic gastritis was endoscopically classified into 2 types with the atrophic pattern system: the closed-type (C-type) and the open-type (O-type). We compared the findings from endoscopy and ambulatory pH monitoring for these 2 types. RESULTS: The O-type was significantly associated with a lower prevalence of reflux esophagitis (p=0.001). All variables showing gastroesophageal reflux in the distal probe were significantly lower in the O-type than in the C-type (p<0.05). Similarly for the proximal probe, all variables, except the supine time of pH<4, were significantly lower in the O-type than in the C-type (p<0.05). The frequency of gastroesophageal reflux disease and gastropharyngeal reflux disease was in significantly lower in the O-type than in the C-type (p<0.001, p=0.012, respectively). CONCLUSIONS: Endoscopic grading of atrophic gastritis is easy and is inversely associated with gastroesophageal and gastropharyngeal reflux.
*Endoscopy, Gastrointestinal ; Esophageal pH Monitoring ; Female ; Gastritis, Atrophic/classification/*physiopathology ; Gastroesophageal Reflux/epidemiology/*physiopathology ; Health Status Indicators ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Pharynx/*pathology ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.2% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.
2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Aged ; Aged, 80 and over ; Anti-Ulcer Agents/*therapeutic use ; Benzimidazoles/*therapeutic use ; Enzyme Inhibitors/*therapeutic use ; Esophageal Diseases/*pathology ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/drug therapy/epidemiology/*pathology ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Omeprazole/*analogs & derivatives/therapeutic use ; Prospective Studies ; Proton-Translocating ATPases/*antagonists & inhibitors ; Treatment Outcome

OBJECTIVETo find the major risk factors associated with gastric cardia cancer.

METHODSWe selected five high incidence areas of esophageal cancer and gastric cancer which have cancer registration system, i.e. Cixian and Shexian of Hebei Province, Linxian of Henan Province, Feicheng of Shandong Province and Zhuanghe of Liaoning Province. Fifty newly diagnosed cases of cardiac cancer after January 1, 2008 were selected from each cancer registration database. A uniform questionnaire, which was fully consulted by experts, was used. Population-based 1:3 case-control study was conducted in those areas. The study recruited 250 cases of cardiac cancer and 750 matched controls, which were investigated with the uniform questionnaire. The data were statistically analyzed by fitting-conditional Logistic analysis.

RESULTSSmoking, passive smoking, alcohol drinking, irregular meal, improper dining posture, heavy taste, dried food, pickled food, fried food, hot food, gastrointestinal history, gastroesophageal reflux disease (GERD) can increase the risk of cardiac cancer. To eat more bean and high BMI are protective factors of the single factor logistic analysis. Gastrointestinal history (OR = 42.899), dried food (OR = 5.932), irregular meal (OR = 4.911), hot food (OR = 4.144), pickled food (OR = 3.287), passive smoking (OR = 2.355), and GERD (OR = 1.930) can increase the risk of cardiac cancer, eat more bean (OR = 0.254) and BMI ≥ 25 (OR = 0.492) are protective factors of the mixture factors logistic analysis.

CONCLUSIONSGastric cardia cancer is caused by environmental risk factors and genetic factors. Health education in high cardiac cancer incidence areas and primary prevention popularized into people's daily life will be beneficial to decreasing the incidence of gastric cardia cancer.

Aged ; Alcohol Drinking ; Body Mass Index ; Cardia ; pathology ; Case-Control Studies ; China ; epidemiology ; Diet ; adverse effects ; Feeding Behavior ; Female ; Gastroesophageal Reflux ; complications ; Humans ; Life Style ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Smoking ; Stomach Neoplasms ; epidemiology ; etiology ; Surveys and Questionnaires

BACKGROUND/AIMS: We aimed to estimate the proportion of significant endoscopic findings and their association with dyspeptic symptoms and to evaluate the predictors for significant endoscopic findings. METHODS: Total of 3,872 subjects (58.3% men, mean age 43.6+/-9.3 years) who had undergone endoscopy were enrolled at the health promotion center. Each subject completed validated questionnaires, including data on gastrointestinal symptoms, socio-demographic history and medical history. Significant endoscopic findings were included peptic ulcer disease, reflux esophagitis, gastric cancer, Barrett's esophagus and gastro-duodenal erosions. Multiple logistic regression models were used to assess the predictors for significant endoscopic findings. RESULTS: The proportion of significant endoscopic findings was 39.1%. There was no significant difference of endoscopic findings between the dyspepsia and asymptomatic group (41.0% vs. 37.4%, p>0.05). There was no difference of the incidence of reflux esophagitis or peptic ulcer between subjects with and without dyspepsia. Peptic ulcer was more frequently present in subjects with reflux symptoms than asymptomatic subjects (12.3% vs. 9.0%, p=0.03). Male gender (odds ratio [OR], 3.91; 95% confidence interval [CI], 3.18-4.81) increased the risk for having endoscopic abnormality and having symptoms of functional dyspepsia according to Rome III criteria (OR, 0.75; 95% CI, 0.57-0.97) significantly decreased this risk. CONCLUSIONS: About 40% of subjects with dyspepsia had abnormal endoscopic findings, and the dyspepsia symptoms may not predict the significant endoscopic findings. Diagnostic criteria of functional dyspepsia by Rome III may be useful to predict not having significant upper endoscopic findings.
Adult ; Aged ; Aged, 80 and over ; Dyspepsia/*diagnosis ; Female ; Gastroesophageal Reflux/diagnosis/epidemiology ; *Gastroscopy ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Peptic Ulcer/diagnosis/epidemiology ; Postprandial Period ; Predictive Value of Tests ; Questionnaires ; Severity of Illness Index ; Sex Factors ; Upper Gastrointestinal Tract/pathology ; Young Adult