Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus

<div><p>Background</p><p>The association of alcohol intake with the incidence of Barrett’s esophagus (BE) has been inconsistent. Although hiatal hernia and male sex are well-known risk factors of BE, its effect on the association of alcohol intake with the incidence of BE remains unknown.</p><p>Aim</p><p>To investigate whether the influence of alcohol intake on the occurrence of BE might differ depending on male sex and presence of hiatal hernia.</p><p>Methods</p><p>We utilized a database of 8031 patients that underwent upper endoscopy for health screening in a prospective, multicenter, cohort study (the Upper Gastro Intestinal Disease study). The incidence of endoscopic columnar-lined esophagus (eCLE; endoscopically diagnosed BE) was the outcome variable. Multivariable logistic regression analysis was conducted to assess the association between alcohol intake and eCLE stratified by male sex and hiatal hernia, adjusting for clinical features and other potential confounders.</p><p>Results</p><p>Alcohol intake (≥20 g/day) showed a marginally significant association with the incidence of eCLE in participants without hiatal hernia (0 vs. ≥20 g/day; odds ratio [OR], 1.62; 95% confidence interval [CI], 0.92–2.85, <i>P</i> = 0.09) but not in participants with hiatal hernia (0 vs. ≥20/day; OR, 0.99; 95% CI, 0.59–1.65; <i>P</i> = 0.95). Furthermore, alcohol intake (≥20 g/day) was significantly associated with the incidence of eCLE in male participants without hiatal hernia (0 vs. ≥20 g/day; OR, 1.98; 95% CI, 1.04–4.03; <i>P</i> = 0.04) but not in female participants without hiatal hernia (0 vs. ≥20 g/day; OR, 0.47; 95% CI, 0.03–2.37; <i>P</i> = 0.42).</p><p>Conclusions</p><p>The effect of alcohol intake on the incidence of eCLE might be associated with hiatal hernia status and male sex.</p></div

Logistic regression analysis of risk factors for endoscopic columnar-lined esophagus (N = 8031).

<p>Logistic regression analysis of risk factors for endoscopic columnar-lined esophagus (N = 8031).</p

Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus stratified by hiatal hernia status in female participants.

<p>Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus stratified by hiatal hernia status in female participants.</p

Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus, stratified by hiatal hernia in male participants.

<p>Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus, stratified by hiatal hernia in male participants.</p

Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus stratified by hiatal hernia status.

<p>Logistic regression analysis to assess the association between alcohol consumption and the occurrence of endoscopic columnar-lined esophagus stratified by hiatal hernia status.</p

Characteristics of participants in UGID study.

<p>Characteristics of participants in UGID study.</p

Factors associated with the presentation of erosive esophagitis symptoms in health checkup subjects: A prospective, multicenter cohort study

<div><p>Background</p><p>We aimed to clarify the factors associated with the presentation of erosive esophagitis (EE) symptoms in subjects undergoing health checkups.</p><p>Methods</p><p>We utilized baseline data from 7,552 subjects who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The subjects were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Based on the heartburn and/or acid regurgitation frequency, the EE subjects were stratified into the following three groups: (1) at least one day a week (symptomatic EE [sEE]), (2) less than one day a week (mild symptomatic EE [msEE]), and (3) never (asymptomatic EE [aEE]). Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were defined according to the Rome III criteria.</p><p>Results</p><p>Of the 1,262 (16.7%) subjects (male 83.8%, mean age 52.6 years) with EE, the proportions of sEE, msEE and aEE were 15.0%, 37.2% and 47.9%, respectively. The sEE group showed significant associations with overlapping EPS (OR: 58.4, 95% CI: 25.2–160.0), overlapping PDS (OR: 9.96, 95% CI: 3.91–26.8), severe hiatal hernia (OR: 2.43, 95% CI: 1.43–4.05), experiencing high levels of stress (OR: 2.20, 95% CI: 1.43–3.40), atrophic gastritis (OR: 1.57, 95% CI: 1.03–2.36) and Los Angeles (LA) grade B or worse (OR: 1.72, 95% CI: 1.12–2.60) in the multivariate analysis.</p><p>Conclusions</p><p>Approximately one-sixth of EE subjects were symptomatic. A multifactorial etiology, including factors unrelated to gastric acid secretion, was associated with the symptom presentation of EE subjects.</p></div

Comparison of clinical characteristics between the subjects with erosive esophagitis and the control group.

<p>Comparison of clinical characteristics between the subjects with erosive esophagitis and the control group.</p

Multivariate analysis of the factors associated with erosive esophagitis compared to the control group.

<p>Multivariate analysis of the factors associated with erosive esophagitis compared to the control group.</p

Characteristics of the study participants.

<p>Characteristics of the study participants.</p