Caucasian ethnicity as a risk factor for more severe mucosal damage in gastroesophageal reflux disease
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Background and aims
In the Western world, 10–20 % of patients with GERD complain of at least weekly episodes of heartburn and/or acid regurgitation, while the corresponding value for GERD patients in Asia is <5 %. Reports of the risk factors for mucosal damage in patients with GERD are scarce. The aim of this study was to compare the severity of mucosal damage according to the Los Angeles system in Japanese and Caucasian residents of Japan who have GERD.
We conducted a retrospective cross-sectional study using 537 patients who visited St. Luke’s International Hospital and Mie University Hospital in Japan with symptoms of heartburn from January 2003 through December 2011. We divided the participants into two ethnic groups: 116 Caucasians (84 males and 32 females), mean age (SD) 43.8 (13.2) years old; and 375 Japanese (192 males and 183 females), mean age (SD) 53.2 (15.5) years old. Patients with a history of previous abdominal surgery or Helicobacter pylori eradication were excluded from the analysis. All patients were examined by esophagogastroduodenoscopy (EGD) to evaluate the severity of mucosal injury and hiatal hernia before medical treatment.
With multivariate ordinal logistic regression analysis, age (OR 1.03, 95 % CI 1.02–1.04, p < 0.001), male gender (OR 2.71, 95 % CI 1.84–4.01), Caucasian ethnicity (OR 1.65, 95 % CI 1.06–2.58, p = 0.0268), and the presence of hiatal hernia (OR 3.35, 95 % CI 2.06–5.46, p = 0.0012) were associated with more severe mucosal injury in GERD.
Patients with reflux symptoms tend to have more severe mucosal damage if they are male, older, Caucasian, or have a hiatal hernia. These patients should be evaluated by EGD more frequently.