Digestive Diseases and Sciences

, Volume 39, Issue 1, pp 183–188 | Cite as

Hospital discharges resulting from esophagitis among medicare beneficiaries

  • Amnon Sonnenberg
  • Benson T. Massey
  • Steven J. Jacobsen
Original Article


Despite the frequent occurrence of gastroesophageal reflux disease, until now only very few studies have dealt with the epidemiology of this common disorder. The Health Care Fionancing Administration compiles annually 10 million records of all hospital discharges among Medicare beneficiaries distributed throughout the United States. The purpose of the present study was to take advantage of this large data set and analyze the demographic characteristics of patients discharged with esophagitis, esophageal ulcer, or esophageal stricture. The hospital discharge rates of all three diagnoses showed an age-related rise, the rise being most pronounced for esophageal stricture and, less significant, esophageal ulcer. The marked age dependency of esophageal stricture and ulcer may reflect the time necessary for complications to develop. While simple esophagitis affected women more frequently than men, significantly more men contracted its severe forms involving ulcers and strictures. All forms were more common in whites than blacks, and living in the southern parts of the United States was associated with an increased risk for esophagitis and strictures. The data suggest that besides varying exposure to environmental risk factors, differences in the pathophysiology among demographically stratified groups contribute to the occurrence of esophagitis.

Key words

Barrett's esophagus epidemiology gastroesophageal reflux disease geriatrics hospitalization statistics peptic esophagitis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Thompson WG, Heaton KW: Heartburn and globus in apparently healthy people. Can Med Assoc J 126:46–48, 1982PubMedGoogle Scholar
  2. 2.
    Andersen LI, Jensen G: Prevalence of benign oesophageal disease in the Danish population with special reference to pulmonary disease. J Intern Med 225:393–401, 1989PubMedGoogle Scholar
  3. 3.
    Gallup Organization. A Gallup Survey on Heartburn Across America. Princeton, New Jersey, The Gallup Organization, 1988Google Scholar
  4. 4.
    Sonnenberg A: Epidemiologie und Spontanverlauf der Refluxkrankheit.In Refluxtherapie. AL Blum, JR Siewert (eds). Berlin, Springer-Verlag, 1981, pp 85–106Google Scholar
  5. 5.
    Tibbling L: Epidemiology of gastro-oesophageal reflux disease. Scand J Gastroenterol 19(suppl 106):14–18, 1984PubMedGoogle Scholar
  6. 6.
    Wienbeck M, Barnert J: Epidemiology of reflux disease and reflux esophagitis. Scand J Gastroenterol 24(suppl 156):7–13, 1989Google Scholar
  7. 7.
    US Department of Health and Human Services, Health Care Financing Administration, Bureau of Data Management and Strategy: Medicare Statistical Files Manual.Google Scholar
  8. 8.
    World Health Organization: The International Classification of Diseases, 9th revision. Clinical Modification, 2nd ed. DHHS Publ. No. (PHS) 80-1260. Washington, DC, Public Health Service, US Government Printing Office, 1980Google Scholar
  9. 9.
    US Bureau of the Census: US Census of Population: 1980. Vol. 1, Chapter B. General Population Characteristics. Washington, DC, US Government Printing Office, 1982Google Scholar
  10. 10.
    Kahn HA, Sempos CT: Statistical Methods in Epidemiology. New York, Oxford University Press, 1989Google Scholar
  11. 11.
    Breslow NE, Day NE: Statistical Methods in Cancer Research, Volume II—The Design and Analysis of Cohort Studies, Lyon, IARC Scientific Publications No. 82. World Health Organization, International Agency for Research on Cancer, 1987, pp 59Google Scholar
  12. 12.
    Snedecor GW, Cochran WG: Statistical Methods, 7th ed. Ames, Iowa, The Iowa State University Press, 1980Google Scholar
  13. 13.
    Office of Population Censuses and Surveys: Occupational mortality. The Registrar General's decennial supplement for Great Britain, 1979–80, 1982–83. Series DS No. 6. Part I, commentary. London, Her Majesty's Stationery Office, 1986, pp 19–28Google Scholar
  14. 14.
    Brossard E, Monnier P, Ollyo JB, Fontolliet C, Levi F, Krayenbühl M, Savary M: Serious complications—stenosis, ulcer and Barrett's epithelium—develop in 21.6% of adults with erosive reflux esophagitis. Gastroenterology 100:A36, 1991Google Scholar
  15. 15.
    Goldschmiedt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M: Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology 101:977–990, 1991PubMedGoogle Scholar
  16. 16.
    Meyer J, Necheles H: Studies in old age. IV. The clinical significance of salivary, gastric and pancreatic secretion in the aged. JAMA 115:2050–2053, 1940Google Scholar
  17. 17.
    Bertram U: Xerostomia: clinical aspects, pathology and pathogenesis. Acta Odontol Scand 25(suppl 49):1–126, 1967PubMedGoogle Scholar
  18. 18.
    Sonnenberg A, Steinkamp U, Weise A, Berges W, Wienbeck M, Rohner HG, Peter P: Salivary secretion in reflux esophagitis. Gastroenterology 83:889–895, 1982PubMedGoogle Scholar
  19. 19.
    Baum BJ: Salivary gland fluid secretion during aging. J Am Geriatr Soc 37:453–458, 1989PubMedGoogle Scholar
  20. 20.
    Schnell T, Sontag S, Miller T, Cheifec G, Kurucar C, O'Connell S: Age, race and alcohol use predict endoscopic esophagitis in patients with symptoms of reflux. Gastroenterology 100:A18, 1991Google Scholar
  21. 21.
    Schnell T, Sontag S, Miller T, Cheifec G, Kurucar C, O'Connell S: Are there identifiable risk factors for the presence of Barrett's esophagus in patients with gastroesophageal reflux? Gastroenterology 100:A156, 1991Google Scholar
  22. 22.
    Mann NS, Tsai MF, Nair PK: Barrett's esophagus in patients with symptomatic reflux esophagitis. Am J Gastroenterol 84:1494–1496, 1989PubMedGoogle Scholar
  23. 23.
    McCallum RW, Polepalle S, Davenport K, Frierson H, Boyd S: Progress report on ACG Barrett's esophagus study. Am J Gastroenterol 85:1228, 1990Google Scholar
  24. 24.
    Nebel OT, Fornes MF, Castell DO: Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis 21:953–956, 1976PubMedGoogle Scholar
  25. 25.
    Andersen LI, Jensen G: Risk factors for benign oesphageal disease in a random population sample. J Intern Med 230:5–10, 1991PubMedGoogle Scholar
  26. 26.
    Cameron AJ, Lomboy CT: Barrett's esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 103:1241–1245, 1992PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Amnon Sonnenberg
    • 1
  • Benson T. Massey
    • 1
  • Steven J. Jacobsen
    • 1
  1. 1.From the Division of Gastroenterology, Division of Biostatistics and EpidemiologyVA Medical Center and the Medical College of WisconsinMilwaukee

Personalised recommendations