Labenz Joachim, Jaspersen Daniel, Kulig Michael, Leodolter Andreas, Lind Tore, Meyer-Sabellek Wolfgang, Stolte Manfred, Vieth Micheal, Willich Stefan, Malfertheiner Peter
Department of Medicine, Jung-Stilling Hospital, Wichernstrasse 40, 57074 Siegen, Germany.
Am J Gastroenterol. 2004 Sep;99(9):1652-6. doi: 10.1111/j.1572-0241.2004.30390.x.
Gastroesophageal reflux disease can be divided into three categories: nonerosive GERD (NERD), erosive GERD (ERD), and Barrett's esophagus. A shift among these categories rarely occurs. The aim of the present study was to elucidate potential patient-associated risk factors associated with ERD.
A total of 6,215 patients with troublesome heartburn were recruited to a large, prospective, multicenter open cohort study comprising an initial treatment phase and a 5-yr follow-up phase. Each center planned to recruit an equal number of patients with NERD and ERD. All patients underwent an interview based on standardized questionnaires, a physical examination, and endoscopy with biopsies. Data were analyzed by multiple logistic regression analysis.
Risk factor analysis was performed on 5,289 patients (NERD: n = 2,834; ERD: n = 2,455), which was the intent-to-treat population excluding patients with suspected/proven complicated reflux disease. Stepwise regression analysis identified the following independent predictors of ERD: male gender, overweight, regular use of alcohol, a history of GERD >1 yr, and smoker or ex-smoker. A higher level of education and a positive Helicobacter pylori (H. pylori) status were associated with a lower risk of ERD.
Some patient-associated factors increase the risk of erosive esophagitis as opposed to nonerosive reflux disease. However, no single factor or combination of factors is capable of predicting mucosal damage with clinically sufficient certainty. Thus, endoscopy is still required in all GERD patients if valid information on the state of the esophageal mucosa is needed.
胃食管反流病可分为三类：非糜烂性胃食管反流病（NERD）、糜烂性胃食管反流病（ERD）和巴雷特食管。这些类别之间很少发生转变。本研究的目的是阐明与糜烂性胃食管反流病相关的潜在患者相关危险因素。
总共6215例有严重烧心症状的患者被纳入一项大型前瞻性多中心开放队列研究，该研究包括初始治疗阶段和5年随访阶段。每个中心计划招募数量相等的非糜烂性胃食管反流病患者和糜烂性胃食管反流病患者。所有患者均接受基于标准化问卷的访谈、体格检查以及内镜活检。通过多元逻辑回归分析对数据进行分析。
对5289例患者（非糜烂性胃食管反流病：n = 2834；糜烂性胃食管反流病：n = 2455）进行了危险因素分析，这是意向性治疗人群，不包括疑似/已证实的复杂性反流病患者。逐步回归分析确定了以下糜烂性胃食管反流病的独立预测因素：男性、超重、经常饮酒、胃食管反流病病史>1年、吸烟者或既往吸烟者。较高的教育水平和幽门螺杆菌（H. pylori）阳性状态与糜烂性胃食管反流病风险较低相关。
与非糜烂性反流病相比，一些患者相关因素会增加糜烂性食管炎的风险。然而，没有单一因素或因素组合能够在临床上足够确定地预测黏膜损伤。因此，如果需要关于食管黏膜状态的有效信息，所有胃食管反流病患者仍需要进行内镜检查。
