Clinical characteristics of gastroesophageal reflux disease in Japan.

BACKGROUND/AIMS: Little is known about the correlation between clinical symptoms in daily life and the endoscopic features of gastroesophageal reflux disease (GERD). The study aim is to evaluate the correlation between clinical symptoms in daily life and endoscopic findings in reflux esophagitis (RE), and endoscopically suspected esophageal metaplasia (ESEM) in a large number of Japanese non-clinical cases. METHODOLOGY: A total of 6504 subjects who underwent an endoscopy for their annual medical check-up at Miyagi cancer society were enrolled in this study. If esophagitis was present, it was graded according to the Los Angeles classification. ESEM describes endoscopic findings consistent with BE that await histological evaluation. It was also investigated the symptom of heartburn as a "typical symptom" of GERD, and dysphagia as an "atypical symptom" of GERD. RESULTS: The prevalence of heartburn and dysphagia significantly increased concomitantly with endoscopic the esophagitis grading. The prevalence of heartburn was significantly higher in subjects with long segment ESEM than those without it. CONCLUSION: The prevalence of heartburn and dysphagia were closely associated with RE grading. Long segment ESEM is strongly associated with the reflux symptom and RE. The more frequent the GERD symptoms, the greater the risk for the development of severe RE, and ESEM.

Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan.

AIM: To examine the prevalence of gastroesophageal reflux disease (GERD) symptoms in a large unselected general population in Japan. METHODS: In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged>40 years. A total of 160983 Japanese (60774 male, 100209 female; mean age 61.9 years) who underwent a stomach check up were enrolled in this study. In addition, from these 160983 subjects, we randomly selected a total of 82894 (34275 male, 48619 female; mean age 62.4 years) to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period. RESULTS: The respective prevalences of the symptoms in males and females were: heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year age group. Dysphagia was also significantly more frequent in female patients. CONCLUSION: The prevalence of typical GERD symptoms (heartburn) was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.

Tongue-like Barrett's esophagus is associated with gastroesophageal reflux disease.

AIM: To test this hypothesis of barrett esophagus (BE) classified into two types and to further determine if there was any correlation between the shape of endoscopically suspected esophageal metaplasia (ESEM), prevalence of reflux esophagitis (RE) and heartburn. METHODS: A total of 6504 Japanese who underwent endoscopy for their annual stomach check-up were enrolled in this study. BE was detected without histological confirmation that is ESEM. We originally classified cases of ESEM into 3 types based on its shape: Tongue-like (T type), Dome-like (D type) and Wave-like (W type) ESEM. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a one-month period. RESULTS: ESEM was observed in 10.3% of 6504 subjects (ESEM < 1 cm, 9.4%; 1 cm < or = ESEM < 3 cm, 1.7%; ESEM > or = 3 cm, 0.5%). The frequency of ESEM was significantly higher in males compared with female subjects. Statistical analysis showed that the prevalence of heartburn and RE were significantly higher in the T type ESEM than in the W type ESEM (P < 0.05). CONCLUSION: The T type ESEM was strongly asso-ciated with reflux symptoms and RE whereas the W type ESEM was not associated with GERD.