Whites in the United States have a 5-fold incidence of esophageal adenocarcinoma, and up to 3 times the prevalence of Barrett's esophagus, compared to blacks.
However, it remains unknown whether this discrepancy reflects lower prevalence of GERD symptoms in blacks, or less esophageal damage for the same degree of symptoms.
In this study, researchers performed a population-based investigation to determine the prevalence of endoscopic esophageal findings in an ethnically diverse population.
Dr Hashem El-Serag's team distributed Gastroesophageal Reflux Questionnaires 915 employees at the Houston VAMC. This was followed by an invitation to undergo upper endoscopy.
Of the 915 employees 57% returned complete questionnaires. Of these, 226 underwent upper endoscopy with gastric biopsies.
|Overweight is an independent risk factor for erosive esophagitis.|
|American Gastroenterological Association|
The research team standardized all endoscopic procedures and biopsy protocols. Procedures were performed by a single endoscopist who was blinded to the results of both the questionnaires and endoscopy.
The presence of erosive esophagitis (EE) was examined using multivariable logistic regression analyses. The team examined the influence of age, gender, ethnicity, GERD symptoms, medications, BMI, Helicobacter pylori infection, and the presence and distribution of gastritis.
Of the 226 participants who underwent endoscopy, 48% were black, and 64% were female. This was the first endoscopy for more than 70% of the participants.
The researchers found that a greater proportion of those who underwent endoscopy had frequent heartburn, than those who did not, 36% versus 21%, respectively. They also reported using PPI, H2RA, or antacids.
The team found EE was found in 50 of the 226 participants (22%), of the 31 had grade A esophagitis. Furthermore, 24 had CLE (23 less than 2 cm), and 1 had Barrett's esophagus
They determined that the prevalence of EE was greater in whites (41%) than in blacks (16%).
Additionally, in those participants with frequent heartburn or regurgitation, EE was present in 45% of whites and 19% of blacks.
When the team controlled for age and BMI, logistic regression showed that black ethnicity was associated with a lower risk of EE.
They also identified BMI greater than 25 as an independent risk factor for EE.
The team did not identify and significant associations between the presence and severity of EE and H. pylori, or the presence of corpus gastritis.
The researchers concluded that blacks in the United States have a lower prevalence of esophagitis than whites, for the same frequency of GERD symptoms.
They also established that grade A EE is relatively common, even in asymptomatic individuals, while Barrett's esophagus is rare.
In addition, overweight is an independent risk factor of EE.