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Official Journals By StatPerson Publication

Table of Content - Volume 12 Issue 3 - December 2019


 

Incidence and precipitating factors of erosive esophagitis in symptomatic gastroesophageal reflux disease

 

Ramprabhu N Tidake1*, Kalpana Chate2, Nitin Chate3

 

1Assistant Professor, 3Associate Professor, Department of Surgery, SRTR Ambejogai, Beed, Maharashtra, INDIA.

2Consutlant Physician and Intensivist, Spandan Critical Care Unit, Barshi Road, Beed, Maharashtra, INDIA.

Email: ramtidake@rediffmail.com

 

Abstract               Background: Gastroesophageal reflux disease (GERD) is one of the major gastrointestinal disorders affecting adults worldwide. Its incidence is increasing due to changing lifestyles and more westernized diet. Several risk factors have been associated with GERD mostly related with lifestyle of patient. Aim: To determine the incidence and precipitating factors of esophagitis in patients presenting with symptoms of gastroesophageal reflux disease (GERD). Material and Methods: A total of 75 patients with complains of upper abdominal pain were selected as symptomatically diagnosed cases of GERD if they had 2 or more of the above symptoms for more than one month were studied for risk factors of erosive esophagitis. Results: Erosive esophagitis was observed endoscopically in 36 patients with symptomatic gastroesophageal reflux disease (GERD). Thus, incidence of erosive esophagitis was 48%. Overall, drinking tea and coffee (97.3%) and spicy food (82.7%) were common in patients with GERD. Conclusion: Incidence of erosive esophagitis in patients with gastroesophageal reflux disease (GERD) is increasing in Indian population. Smoking and obesity were the most common precipitating factors. Cessation of smoking and weight reduction can be considered for the life-style modification.

Key Word: Erosive esophagitis, gastroesophageal reflux disease, incidence, risk factors, smoking, obesity

 

 

INTRODUCTION

Gastroesophageal reflux disease (GERD) develops when the stomach contents reflux and rise up into the esophagus as a result from lower esophageal sphincter dysfunction and/or large hiatal hernia and it is one of the most common chronic gastrointestinal disorder in adults.1 Reflux symptoms are commonly experienced by many people. As per Asian studies, the prevalence of gastroesophaeal disease in the general population is 2.5-7.1%. This trend is however increasing due to changing lifestyles and more westernized diet. Comparative studies amongst Asian populations have found Indians more prone to gastroesophageal reflux disease (GERD).2,3 Several risk factors have been associated with GERD, such as analgesics intake (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), types of food, types of drinks, smoking, family history, high body mass index (BMI), physical activities, salt, or pickles consumption with meals and fast food. These risk factors are mostly related to the lifestyle of the patient.4,5 The present study was conducted to determine the incidence and precipitating factors of esophagitis in patients presenting with symptoms of gastro-oesophageal reflux disease (GERD).

 

MATERIAL AND METHODS

A cross-sectional study was conducted using a self-administered structured questionnaire over a period of two years after obtaining the ethical approval from Institutional Ethics committee. A case definition of gastroesophagal reflux disease (GERD) as a group of symptoms was formed. Symptoms such as heartburn, regurgitation, dysphagia, epigastric pain, watery brash, nausea, bloating sensation, sore throat, hoarseness of voice and persistant cough were considered. A total of 75 patients coming to medicine OPD with complains of upper abdominal pain were selected as symptomatically diagnosed cases of GERD if they had 2 or more of the above symptoms for more than one month. Detailed history of the patient was taken with regards to the symptoms and precipitating factors. Thorough clinical examination of the patients was done. Routine hematological examination of the patient was done.ECG and USG abdomen was done to rule out cardiac and abdominal pathologies respectively.

Inclusion criteria

  • Patients who had symptoms consistent with symptoms of gastroesophageal reflux disease (GERD).
  • At least 2 symptoms were occurring for more than one month.

Exclusion criteria

  • Patients with history of intake of drugs known to cause esophageal motility disorders.
  • Patients with age less than 14 yrs.

 

RESULTS

Amongst 75 patients, the most common age group was 31-40 years (24%) followed by 21-30 years (22%) and 41-50 years (22%). Males outnumbered females with male to female ratio of 1.08:1.Majority 42 (56%) of the patients had BMI of 25.01-30 kg/m2.

Table 1: Characteristics of study population

Parameters

No. of patients

Percentage

Age groups

14-20 yrs

21-30 yrs

31-40 yrs

41-50 yrs

51-60 yrs

³61 yrs

Sex

Male

Female

BMI

£20

20.01-25

25.01-30

>30

 

09

16

18

16

11

05

 

39

36

 

01

30

42

02

 

12%

21.3%

24%

21.3%

14.7%

6.7%

 

52%

48%

 

1.3%

40%

56%

2.7%

Erosive esophagitis was observed endoscopically in 36 patients with symptomatic gastroesophageal reflux disease (GERD). Thus, incidence of erosive esophagitis was 48%.Heartburn was the most common symptom found in 34 patients of erosive esophagitis (94.4%) followed by regurgitation in 29 patients (80.5%). 73 (97.3%) drink coffee and/or tea regularly. Regular drinking was defined as more than once a day. 62 (82.7%) eat spicy food regularly; this defined as three or more meals a week. 36 (92.3%) men were regular smokers. Overall, drinking tea and coffee (97.3%) and spicy food (82.7%) were common in patients with GERD.

 

Table 2: Precipitating factors

Precipitating factors

No. of patients

Males

Females

Smoking

36 (48%)

36 (92.3%)

0 (0%)

Tobacco chewing (including gutkha)

35 (46.7%)

33 (84.6%)

2 (5.5%)

Alcohol

24 (32%)

24 (61.5%)

0 (0%)

Teaand/ coffee

73 (97.3%)

37 (94.9%)

36 (100%)

Spicy food

62 (82.7%)

36 (92.3%)

26 (92.2%)

 


DISCUSSION

Gastroesophageal reflux disease (GERD) is a common cause of upper abdominal discomfort and is one of the commonest pathology affecting the esophagus. But incidence and prevalence of these symptoms does not correlate with the true incidence of reflux esophagitis as many people experience reflux only for a short duration and most of the refluxed material is cleared by the esophageal contractions as well as being neutralised by saliva. In our study, we found that gastroesophageal reflux disease (GERD) was more common in the age group 31-40 years (24% cases) followed by 41-50 years and 21-30 years age groups. Mean age of patients in our study was 38.06 years. As per other studies gastroesophageal reflux disease (GERD) was more in patients above 50 yrs.6-8 However, Asian studies showed that gastroesophageal reflux disease occurred earlier due to lifestyle modification. We found that gastroesophageal reflux disease (GERD) was more common in males as compared to females. M:F ratio was 1.08:1. Kimet al in their study found gastroesophageal reflux disease (GERD) more common in females as compared to males.9 Viashnav et al found a positive correlation between gastroesophageal reflux disase(GERD) and obesity. In maximum patients the BMI was found in range 25.01-30 kg/sqm. The average BMI was 25.30 kg/sqm.10 Thus, weight reduction may be a lifestyle modification which would help to alleviate symptoms of gastroesophageal reflux disease (GERD). We found the incidence of erosive esophagitis in patients with symptoms of gastroesophageal reflux disease (GERD) as 48%. This is contrary to the earlier assumption that gastroesophageal reflux disease is less prevalent in Asian countries. It also indicates that changing lifestyles and westernized diet with increasing obesity are Increasing the prevalence of gastroesophageal reflux disease (GERD) and erosive esophagitis closer to incidence rates in the west.

 

Table 3: Comparative studies of incidence of erosive esophagitis in patients with symptoms of GERD

Study

Country

Year

Incidence

Behar et al11

Sweden

1976

35%

Johansen et al12

U.K

1986

9.9%

Howard et al13

U.S.A

1992

46%

Chang et al14

China

1997

18.5%

Voutilainen et al15

Finland

2000

60%

Our study

India

2013

48%

In our study, overall patients with gastroesphageal reflux disease showed a high prevalence of taking spicy diet (82.7%) and tea or coffee drinking. (97.3%) while males in a high percentage showed smoking (100%). Previous studies also observed that alcohol drinking and smoking are the major risk factors for erosive esophagitis in patients with gastroesphageal reflux disease.16,17

 

CONCLUSION

Incidence of erosive esophagitis in patients with gastroesophageal reflux disease (GERD) is increasing in Indian population as compared to previous studies. Smoking and obesity were the most common precipitating factors.Cessation of smoking and weight reduction can be considered for the life-style modification.

 

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