El-Serag H B, Johanson J F
Gastroenterology and Health Services Research, Houston VA Medical Center, Baylor College of Medicine, Texas 77030, USA.
Scand J Gastroenterol. 2002 Aug;37(8):899-904. doi: 10.1080/003655202760230847.
The risk factors for the varying grades of erosive esophagitis (EE) severity could be better understood. For that reason. we evaluated the risk factors associated with EE in patients with gastroesophageal reflux disease.
We determined the presence and severity of EE (using the Los Angeles Classification) in patients with negative serology Helicobacterpylori who underwent esophagogastroduodenoscopy as part of screening in four prospective, multicenter, randomized, double-blind comparative trials of once-daily esomeprazole and omeprazole for the acute healing of erosive esophagitis. We also examined the baseline characteristics of enrolled patients, and identified risk factors for severe disease using a multivariable logistic regression model.
Erosive esophagitis was documented in 6709 patients of a total of 10,294 patients who underwent endoscopy: of these. 34% had grade A. 39% had grade B. 20% had grade C. and 7% had grade D disease. The majority of patients were male (61%) and Caucasian (93%) with a mean age of 46 years. In the regression model, the following were significant independent risk factors for severe (grades C and D) versus mild erosive esophagitis (grades A and B): severe heartburn (adjusted odds ratio 1.79); prolonged heartburn > 5 years in duration (1.16); obesity (1.21); the presence of hiatus hernia (2.13); male gender (1.97); and Caucasian ethnicity (1.53).
In this large sample of patients with predominantly H. pylori-negative gastroesophageal reflux disease, risk factors for severe erosive esophagitis were the duration and severity of heartburn, and obesity.
不同程度的糜烂性食管炎（EE）严重程度的风险因素能得到更好的理解。因此，我们评估了胃食管反流病患者中与EE相关的风险因素。
在四项每日一次使用埃索美拉唑和奥美拉唑治疗糜烂性食管炎急性愈合的前瞻性、多中心、随机、双盲对照试验中，我们确定了血清学检测幽门螺杆菌阴性且接受食管胃十二指肠镜检查的患者中EE的存在及严重程度（采用洛杉矶分类法）。我们还检查了入组患者的基线特征，并使用多变量逻辑回归模型确定严重疾病的风险因素。
在总共10294例接受内镜检查的患者中，有6709例记录有糜烂性食管炎：其中，34%为A级，39%为B级，20%为C级，7%为D级。大多数患者为男性（61%）和白种人（93%），平均年龄46岁。在回归模型中，以下因素是严重（C级和D级）与轻度糜烂性食管炎（A级和B级）相比的显著独立风险因素：严重烧心（调整比值比1.79）；烧心持续时间>5年（1.16）；肥胖（1.21）；存在食管裂孔疝（2.13）；男性（1.97）；以及白种人种族（1.53）。
在这个以幽门螺杆菌阴性为主的胃食管反流病患者大样本中，严重糜烂性食管炎的风险因素是烧心的持续时间和严重程度以及肥胖。
