Risk factors for erosive and non-erosive gastroesophageal reflux disease and Barrett's esophagus in Nothern Sardinia

<p><b>Objective:</b> Gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma have been increasing. We studied the relationship of conventional risk factors and <i>Helicobacter pylori</i> infection in patients with erosive and non-erosive GERD and Barrett’s esophagus.</p> <p><b>Materials and methods:</b> This was a retrospective study of dyspeptic patients undergoing upper endoscopy between 2002 and 2013. Following endoscopy, those with previously undiagnosed GERD were sub-grouped into non-erosive GERD (NERD), erosive GERD (eGERD), or Barrett's esophagus. <i>H. pylori</i> status was confirmed by 2 positive tests.</p> <p><b>Results:</b> About 5156 patients were included, GERD was present in 65.6% including 1992 with NERD and 1392 with eGERD. About 1772 dyspeptic patients without symptoms of reflux and/or esophagitis served as controls. A hiatal hernia increased the risk of both eGERD and NERD. eGERD was more prevalent among the obese (OR =1.72, <i>p</i> < 0.001), men (OR =1.38, <i>p</i> < 0.001) and current smokers. <i>Helicobacter pylori</i> infection was significantly more common among those with NERD (OR =1.17 versus 1.01, <i>p</i> = 0.046). Logistic regression analysis for eGERD and NERD using age, gender, body mass index, <i>H. pylori</i> infection, hiatal hernia, and smoking showed that overweight and hiatal hernia were significant risk factors for eGERD, and female gender for NERD. Male gender, eGERD and age >50 years were the major risk factors for Barrett’s esophagus.</p> <p><b>Conclusions:</b> The epidemiology of eGERD and NERD suggests differences in pathogenesis, and prevention and treatment strategies should be separately examined in men and women.