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Background: Erosive esophagitis (EE) is experimentally and epidemiologically linked to Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). The authors speculated that the increased availability of proton pump inhibitor (PPI) medications may alter the epidemiology of erosive reflux disease.
Methods: Between 1991 and 2009, 18,000 inhabitants of Olmsted County, Minnesota were identified by the Rochester Epidemiology Project as having undergone diagnostic upper endoscopy (EGD). A review of medical records was performed on a random 10% sample of cases. Incidence of EE was calculated based on the initial EGD of each case, and was correlated with demographic and medical history data.
Results: Of the 1792 records reviewed, the incidence of EE was 22.3% (by LA Classification: Grade D, 0.9%; Grade C, 2.8%; Grade B, 6.8%; Grade A, 11.8%). EE was associated strongly with male gender, but not with patient age or obesity. PPI use history among cases significantly increased throughout the study, from 7% in the period 1991-1997 to 25% in 1998-2003 to 42% in the period 2004-2009. Rates of EE in the time periods were 26%, 22%, and 21% respectively. Cases with history of PPI use had significantly lower incidence of EE (PPI use, 18%; no PPI use, 26%; p=0.004, Fisher's exact test), despite higher likelihood of reflux-related complaints. Including analysis of 1354 subsequent EGD in 676 cases, 7.5% of all cases had finding of endoscopically suspected esophageal metaplasia (ESEM) on any EGD; BE/EAC was found in 3.5% of all cases. ESEM and BE/EAC were each present at initial EGD or followed EE in 90%.
Conclusions: Early treatment of reflux symptoms with PPI medication may be protective of development of erosive esophagitis and may decrease the likelihood of future development of Barrett's esophagus and esophageal adenocarcinoma.