J Neurogastroenterol Motil.  2022 Jan;28(1):86-94. 10.5056/jnm20237.

Predictive Factors for Future Onset of Reflux Esophagitis: A Longitudinal Case-control Study Using Health Checkup Records

  • 1Department of Internal Medicine, Hidaka Hospital, Takasaki, Gunma, Japan
  • 2Department of Internal Medicine, Mitsubishi Mihara Hospital, Mihara, Hiroshima, Japan
  • 3Junpukai Health Maintenance Center, Okayama, Okayama, Japan
  • 4Health Center, Shimane Environment and Health Public Corporation, Matsue, Shimane, Japan
  • 5Department of Internal Medicine, Meiwa Hospital, Nishinomiya, Hyogo, Japan
  • 6Department of Preventive Medicine, Matsue Red Cross Hospital, Matsue, Shimane, Japan
  • 7Public Health Center, Okazaki City Medical Association, Okazaki, Aichi, Japan
  • 8Department of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu, Saga, Japan
  • 9Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan
  • 10Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
  • 11Department of Laboratory Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • 12Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
  • 13Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
  • 14Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan


Although risk factors of reflux esophagitis (RE) have been investigated in numerous cross-sectional studies, little is known about predictive factors associated with future onset of RE. We investigated time courses of clinical parameters before RE onset by a longitudinal case-control study using health checkup records.
We used health checkup records between April 2004 and March 2014 at 9 institutions in Japan. A multivariate logistic regression analysis was performed to evaluate associations of baseline clinical parameters with RE. The time courses of the clinical parameters of RE subjects were compared with those of non-RE subjects by the mixed-effects models for repeated measures analysis or longitudinal multivariate logistic analysis.
Initial data were obtained from 230 056 individuals, and 2066 RE subjects and 4132 non-RE subjects were finally included in the analysis. Body mass index, alanine aminotransferase, smoking, acid reflux symptoms, hiatal hernia, and absence of atrophic gastritis at baseline were independently associated with RE. The time courses of body mass index, fasting blood sugar, triglyceride, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, percentages of acid reflux symptoms, feeling of fullness, and hiatal hernia in the RE group were significantly worse than in the non-RE group.
The RE group displayed a greater worsening of the clinical parameters associated with lifestyle diseases, including obesity, diabetes, hyperlipidemia, and fatty liver for 5 years before RE onset compared with the non-RE group. These results suggest that RE is a lifestyle disease and thus lifestyle guidance to at-risk person may help to prevent RE onset.


Epidemiology; Esophagitis; Longitudinal studies; Risk factors
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