Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2022; 28(8): 853-867
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.853
Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology
Yoo Min Han, Su Jin Chung, Seokha Yoo, Jong In Yang, Ji Min Choi, Jooyoung Lee, Joo Sung Kim
Yoo Min Han, Su Jin Chung, Jong In Yang, Ji Min Choi, Jooyoung Lee, Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
Seokha Yoo, Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
Joo Sung Kim, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
Author contributions: Han YM, Chung SJ designed and performed the research and wrote the paper; Yoo S designed the research and contributed to the analysis; Yang JI, Choi JM, Lee J collected the patients’ clinical data and provided clinical advice; Kim JS provided clinical advice and supervised the report; and all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the International Review Board of Seoul National University Hospital (IRB No. H-1701-028-655).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data. Written informed consent was waived by the Ethics Committee of the designated hospital.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: Some or all data and code generated or used during the study are available from the corresponding author by request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su Jin Chung, MD, PhD, Professor, Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, 39th floor, GFC building 152, Teheran Ro, Gangnam-gu, Seoul 06236, South Korea. medjsj7@snuh.org
Received: August 13, 2021
Peer-review started: August 13, 2021
First decision: October 2, 2021
Revised: October 29, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 28, 2022
Processing time: 195 Days and 0.3 Hours
Abstract
BACKGROUND

Helicobacter pylori (H. pylori) infection is known to prevent the occurrence of gastroesophageal reflux disease (GERD) by inducing gastric mucosal atrophy. However, little is known about the relationship between atrophic gastritis (AG) and GERD.

AIM

To confirm the inverse correlation between AG and the occurrence and severity of GERD.

METHODS

Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included. The grade of reflux esophagitis was evaluated according to the Los Angeles classification. Endoscopic AG (EAG) was categorized into six grades. Serologic AG (SAG) was defined as pepsinogen I ≤ 70 ng/mL and pepsinogen I/II ratio ≤ 3.0. The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.

RESULTS

In total, 4684 individuals with GERD were compared with 21901 healthy controls. In multivariate logistic regression analysis, advanced age, male sex, body mass index > 23 kg/m2, presence of metabolic syndrome, current smoking, and alcohol consumption were associated with an increased risk of GERD. Seropositivity for H. pylori immunoglobulin G antibodies was associated with a decreased risk of GERD. There was an inverse correlation between the extent of EAG and occurrence of GERD: Odds ratio (OR), 1.01 [95% confidence interval (CI): 0.90-1.14] in C1, 0.87 (0.78-0.97) in C2, 0.71 (0.62-0.80) in C3, 0.52 (0.44-0.61) in O1, 0.37 (0.29-0.48) in O2, and 0.28 (0.18-0.43) in O3. Additionally, the extent of EAG showed an inverse correlation with the severity of GERD. The presence of SAG was correlated with a reduced risk of GERD (OR = 0.49, 95%CI: 0.28-0.87, P = 0.014).

CONCLUSION

The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD. AG followed by H. pylori infection may be independently protect against GERD.

Keywords: Gastroesophageal reflux disease; Reflux esophagitis; Helicobacter pylori; Atrophic gastritis; Pepsinogen

Core Tip: This is a retrospective study to evaluate the inverse correlation of atrophic gastritis and the occurrence and severity of gastroesophageal reflux disease (GERD). Old age, male sex, body mass index over 23 kg/m2, metabolic syndrome, current smoking, and alcohol intake increased the risk of GERD. Seropositivity for Helicobacter pylori (H. pylori) immunoglobulin G antibody decreased the risk of GERD. There was an inverse correlation between extent of endoscopic atrophic gastritis (EAG) and occurrence of GERD. Additionally, extent of EAG showed inverse correlation with severity of GERD. Presence of serologic atrophic gastritis was correlated with reduced risk of GERD. Atrophic gastritis followed by H. pylori infection could be an inde-pendent protective factor against GERD.