A Prospective Multicenter Study on the Prevalence and Symptoms of Erosive Reflux Esophagitis in Secondary and Tertiary Hospitals in Korea

Jin Ki Hwang; Juhyung Kim; Seung Goun Hong; Sung Joo Jung; Moon Kyung Joo; Beom Jae Lee; Jong-Jae Park; Jae Seon Kim; Young-Tae Bak

doi:10.4166/kjg.2009.53.5.283

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Hwang, Kim, Hong, Jung, Joo, Lee, Park, Kim, and Bak: A Prospective Multicenter Study on the Prevalence and Symptoms of Erosive Reflux Esophagitis in Secondary and Tertiary Hospitals in Korea

Original Article

Korean J Gastroenterol 2009;53(5):283-291.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.53.5.283

A Prospective Multicenter Study on the Prevalence and Symptoms of Erosive Reflux Esophagitis in Secondary and Tertiary Hospitals in Korea

Jin Ki Hwang, M.D., Juhyung Kim, M.D., Seung Goun Hong, M.D., Sung Joo Jung, M.D., Moon Kyung Joo, M.D., Beom Jae Lee, M.D., Jong-Jae Park, M.D., Jae Seon Kim, M.D., Young-Tae Bak, M.D.

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to: Young-Tae Bak, M.D. Department of Gastroenterology, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: +82-2-2626-1778, Fax: +82-505-115-1778 E-mail: drbakyt@korea.ac.kr

Received 13 November 2008 Accepted 21 November 2008

Abstract

Background/Aims

Recent studies suggest that the prevalence of erosive esophagitis (EE) is increasing in Asia. The aims of this study were to determine the prevalence of EE among outpatients visiting gastroenterology clinics of secondary and tertiary hospitals in Korea, and to analyze their symptoms.

Methods

From May to July 2003, outpatients undergoing their first upper gastrointestinal endoscopies after visiting gastroenterology clinics in secondary and tertiary hospitals in Korea were enrolled. Prevalence of EE was calculated from their endoscopic findings, and symptoms were analyzed from the validated symptom questionnaire.

Results

Among 4,275 cases from 24 hospitals, 506 (11.8%) had EE. Among 836 cases with predominantly typical GERD symptoms, EE was diagnosed in 140 (16.7%). Among 530 cases having predominantly typical GERD symptoms with a frequency of at least twice a week or with a significant impact on their daily lives, EE was found in 104 (19.6%). The prevalence of EE was positively associated with males irrespective of age, old aged (≥65 years) females, predominantly typical GERD symptoms at least twice a week, and the numbers of typical GERD symptoms. The severity of GERD symptoms did not affect the prevalence of EE. The most common typical and atypical GERD symptoms in cases with EE were regurgitation and epigastric soreness, respectively.

Conclusions

The prevalence of EE among outpatients visiting gastroenterology clinics in Korea was 11.8%. Independent factors associated with increased prevalence of EE were males irrespective of age, old aged (≥65 years) females, number of typical GERD symptoms, and frequent typical GERD symptoms.

Keywords: Reflux esophagitis, Endoscopy, Prevalencesymptoms

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Fig. 1.

Flow chart of enrolled patients.

∗ 47 cases had both gastric and duodenal ulcers and 4 cases had both gastric cancers and gastric or duodenal ulcers.

Fig. 2.

Prevalence of erosive esophagitis according to the predominant symptoms. Erosive esophagitis was more frequently diagnosed in cases with predominantly typical gastroesophageal reflux disease symptoms than in those with atypical symptoms.

Fig. 3.

Prevalence of erosive esophagitis in cases with frequent or severe symptoms. Erosive esophagitis was more frequently diagnosed in cases with frequent (at least twice a week) or severe predominantly typical symptoms than in those with frequent or severe predominantly atypical symptoms.

Table 1.

Ten Symptoms Listed in the Questionnaire

1.	가슴이 따갑다 또는 쓰리다.
2.	가슴 가운데 부분에 타는 듯한 또는 뜨거운 듯한 불편감이나 통증이 있다.
3.	목구멍이나 입으로 신 물 또는 쓴 물이 올라온다.
4.	가슴이 아프다 또는 뻐근하다.
5.	음식을 삼킬 때 걸리거나 잘 내려가지 않는다.
6.	목에 뭔가 걸려 있는 또는 붙어 있는 것 같다.
7.	목이 간질간질하거나 목소리를 맑게 하기 위해 헛기침을 한다.
8.	목이 자주 쉬는 경향이 있다.
9.	명치 아래에 고춧가루를 뿌려놓은 것처럼 화끈거린다.
10.	명치에서 배꼽 사이가 쓰리거나 아프다.

Table 2.

Age and Gender Distribution of the Study Subjects (n=4,275)

Age, years	Male, n (%)	Female, n (%)	Total, n (%)
10-19	27 (1.4%)	29 (1.2%)	56 (1.3%)
20-29	185 (9.8%)	208 (8.7%)	393 (9.2%)
30-39	376 (19.9%)	391 (16.4%)	767 (17.9%)
40-49	486 (25.7%)	573 (24.0%)	1,059 (24.8%)
50-59	283 (20.3%)	615 (25.8%)	998 (23.3%)
60-69	327 (17.3%)	430 (18.0%)	757 (17.7%)
70-	105 (5.6%)	140 (5.9%)	245 (5.7%)
Total (mean age± SD)	1,889 (100.0%)	2,386 (100.0%)	4,275 (100.0%)
Total (mean age± SD)	(47.4±14.1)	(48.7±14.0)	(48.1±14.1)

Table 3.

Prevalence of Erosive Esophagitis according to Gender (n=4,275)

	Erosive esophagitis		Total	Prevalence	p-value
	Yes	No	Total	Prevalence	p-value
Male	332	1,557	1,889	17.6%	＜0.001
Female	174	2,212	2,386	7.3%	＜0.001
Total	506	3,769	4,275	11.8%

Table 4.

Prevalence of Erosive Esophagitis according to Age (n=4,275)

Age, years	Erosive esophagitis		Total P	Prevalence	p-value
Age, years	Yes	No	Total P	Prevalence	p-value
-29	42	407	449	9.4%	0.085
30-39	99	668	767	12.9%	0.311
40-49	124	935	1,059	11.7%	0.883
50-59	104	894	998	10.4%	0.114
60-69	100	657	757	13.2%	0.197
70-	37	208	245	15.1%	0.103
Total (mean age± SD)	506	3,769	4,275	11.8%
	(48.9±14.4))	(48.0±14.0)	(48.1±14.1)

Table 5.

Prevalence of Erosive Esophagitis according to the Predominant Symptoms (n=3,654)

		Symptoms	Frequent (≥2x/week) or clinically significant symptoms^∗	Total^∗
Typical symptoms	1.	가슴이 따갑다 또는 쓰리다.	32/235 (13.6%)	45/345 (13.0%)
	2.	가슴 가운데 부분에 타는 듯한 또는 뜨거운 듯한 불편감이나 통증이 있다.	13/86 (15.1%)	16/128 (12.5%)
	3.	목구멍이나 입으로 신 물 또는 쓴 물이 올라온다.	59/209 (28.2%)	79/363 (21.8%)
		Subtotal:	104/530 (19.6%)	140/836 (16.7%)
Atypical symptoms	4.	가슴이 아프다 또는 뻐근하다.	34/229 (14.8%)	49/388 (12.6%)
	5.	음식을 삼킬 때 걸리거나 잘 내려가지않는다.	15/137 (10.9%)	22/177 (12.4%)
	6.	목에 뭔가 걸려 있는 또는 붙어 있는 것 같다.	36/271 (13.3%)	41/354 (11.6%)
	7.	목이 간질간질하거나 목소리를 맑게 하기 위해 헛기침을 한다.	15/111 (13.5%)	21/183 (11.5%)
	8.	목이 자주 쉬는 경향이 있다.	1/37 (2.7%)	3/64 (4.7%)
	9.	명치 아래에 고춧가루를 뿌려놓은 것처럼 화끈거린다.	26/161 (16.1%)	32/224 (14.3%)
	10.	명치에서 배꼽 사이가 쓰리거나 아프다.	78/676 (11.5%)	107/1,055 (10.1%)
	11.	기타 증상	4/43 (9.3%)	33/373 (8.8%)
		Subtotal:	209/1,665 (12.6%)	308/2,818 (10.9%)
		Total	313/2,195 (14.3%)	448/3,654 (12.3%)

^∗ Cases with erosive esophagitis/total cases of each group (% prevalence of erosive esophagitis).

Table 6.

Predominant Symptoms in Patients with Erosive Esophagitis (n=448)

	Symptoms		n (%)
Typical symptoms	1.	가슴이 따갑다 또는 쓰리다.	45 (10.0%)
	2.	가슴 가운데 부분에 타는 듯한 또는 뜨거운 듯한 불편감이나 통증이 있다.	16 (3.6%)
	3.	목구멍이나 입으로 신 물 또는 쓴 물이 올라온다.	79 (17.6%)
		Subtotal:	140 (31.3%)
Atypical symptoms	4.	가슴이 아프다 또는 뻐근하다.	49 (10.9%)
	5.	음식을 삼킬 때 걸리거나 잘 내려가지 않는다.	22 (4.9%)
	6.	목에 뭔가 걸려 있는 또는 붙어 있는 것 같다.	41 (9.2%)
	7.	목이 간질간질하거나 목소리를 맑게 하기 위해 헛기침을 한다.	21 (4.7%)
	8.	목이 자주 쉬는 경향이 있다.	3 (0.7%)
	9.	명치 아래에 고춧가루를 뿌려놓은 것처럼 화끈거린다.	32 (7.1%)
	10.	명치에서 배꼽 사이가 쓰리거나 아프다.	107 (23.9%)
	11.	기타 증상	33 (7.4%)
		Subtotal:	308 (68.7%)
		Total	448 (100.0%)

Table 7.

Factors Associated with Erosive Esophagitis (Univariate Analysis)

Variables	Prevalence of reflux esophagitis (%)^∗	p-value	OR	95% CI
Gender and age
Females ＜65 years	123/1859 (6.6%)
Females ≥65 years	40/263 (15.2%)^†	＜0.001	2.53	1.73-3.71
Males ＜65 years	248/1,339 (18.5%)^†	＜0.001	3.21	2.55-4.03
Males ≥65 years	37/193 (19.2%)^†	＜0.001	3.35	2.24-5.01
Number of typical GERD symptoms
0	148/1673 (8.8%)
≥1	300/1981 (15.1%)	＜0.001	1.84	1.49-2.27
1	163/1,251 (13.0%)^‡	＜0.001	1.54	1.22-1.95
2	100/571 (17.5%)^‡	＜0.001	2.19	1.66-2.88
3	37/159 (23.3%)^‡	＜0.001	3.13	2.09-4.68
Frequency of predominantly typical GERD symptoms
＜1/week	18/186 (9.7%)
≥1/week	116/619 (18.7%)	0.003	2.15	1.27-3.64
1/week	19/136 (14.0%)^§	0.289	1.52	0.76-3.00
≥2/week	43/245 (17.6%)^§	0.025	1.99	1.11-3.57
Daily	54/238 (22.7%)^§	＜0.001	2.74	1.54-4.86
Severity of predominantly typical GERD symptoms
Mild	23/170 (13.5%)^∥
Moderate	65/398 (16.3%)^∥	0.449	1.25	0.75-2.09
Severe	46/240 (19.2%)^∥	0.142	1.52	0.88-2.61

^∗ Cases with erosive esophagitis/total cases of each group (% prevalence of erosive esophagitis).

^† p=0.408 by chi-square test among groups.

^‡ p＜0.001 by linear by linear association for trend test.

^§ p±0.031 by linear by linear association for trend test.

^∥ p=0.128 by linear by linear association for trend test.

Table 8.

Factors Associated with Erosive Esophagitis (Multi-variate Analysis)

Variables	p-value	OR	95% CI
Gender and old age
Females ≥65 years	＜0.001	2.48	1.68-3.66
Males ＜65 years	＜0.001	3.44	2.73-4.35
Males ≥65 years	＜0.001	3.81	2.53-5.74
Number of typical GERD symptoms^∗
1	＜0.001	1.62	1.26-2.08
2	＜0.001	2.28	1.69-3.09
3	＜0.001	3.07	1.98-4.74
Frequent predominantly typical GERD symptoms (≥2/week)	0.021	1.39	1.05-1.84

^∗ Each compared with cases without typical symptoms.

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