Prevalence of asymptomatic erosive esophagitis and factors associated with symptom presentation of erosive esophagitis

Objective. Asymptomatic erosive esophagitis (EE) is incidentally found during endoscopy for health screening. The authors have aimed to investigate the prevalence of asymptomatic EE in subjects undergoing health checkups and factors associated with symptom presentation of EE. Methods. Among the consecutive 13,342 adults who underwent esophagogastroduodenoscopy in health checkup programs of Ajou University Hospital from May 2010 to April 2011, 8840 subjects (5683 men and 3157 women; median age, 45 years) who met the enrollment criteria were included in the analysis. They completed a questionnaire that evaluated smoking, medication history, anxiety, depression, esophagopharyngeal symptoms, and dyspeptic symptoms. The mucosal damage of the esophagus was assessed using the Los Angeles classification system. Individuals who had EE but no esophagopharyngeal symptoms were classified into the asymptomatic EE group. Results. A total of 768 subjects were diagnosed with gastroesophageal reflux disease based on the occurrence of heartburn and/or acid regurgitation at least once a week. The prevalence of symptomatic and asymptomatic EE in 8840 subjects was 4.3% and 3.3%, respectively. About 43% of individuals with EE did not exhibit any esophagopharyngeal symptoms. Male gender and postprandial distress syndrome were independently associated with asymptomatic EE. Male gender, current smoking, anxiety, epigastric pain syndrome (EPS), and postprandial distress syndrome were independently associated with symptomatic EE. Compared with the asymptomatic EE group, anxiety and EPS were independent factors associated with symptomatic EE. Conclusions. Asymptomatic EE is common in subjects undergoing a health checkup. The coexistence of anxiety or EPS appears to be the predictors for the symptom presentation of EE.