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1 [ ] Barrett ~89( ) 78.7% 21.3% Barrett 87.7% Barrett 8.3% Barrett 3.9% 61.4% 20.4% 18.2% () Barrett ( P=0.012) (P>0.013) 18~39 40~ ~59 (P=0.007) 18~39 40~59 60 (P>0.013) 60 18~39 40~59 (P=0.004 P=0.008) 18~39 40~59 (P>0.013) [ ] Barrett [ ] R571 [ ] A [ ] (2018) [DOI] /j.issn General gastroscopy of gastroesophageal reflux disease: Analysis of 4086 cases HU Zhi-wei 1, TIAN Shu-rui 1, WU Ji-min 1*, WANG Zhong-gao 1, ZHANG Yu 1, WANG Feng 1, DU Xing 1, ZHANG Dan 2 1 Gastroesophageal Reflux Disease Department, 2 Endoscopy Center, Rocket Force General Hospital of PLA, Beijing , China * Corresponding author, drjiminwu@126.com This work was supported by the Capital Clinical Characteristic Application Research Project (Z ) [Abstract] Objective To analyze the characteristics of gastroesophageal reflux disease (GERD) under general gastroscope. Methods The detection rates of GERD related abnormalities such as esophagitis, Barrett esophagus and hiatal hernia under the first gastroscopy of the adult GERD patients from January 2013 to January 2017 in our center and the statistical relationship between the abnormal findings were analyzed retrospectively. Results A total of 4086 GERD patients, 2004 males and 2082 females, were included in this study, and the age was 18-89( ) years old. The detection rate of non erosive GERD was 78.7%, esophagitis 21.3%; non Barrett esophagus 87.7%, suspected Barrett esophagus 8.3%, Barrett esophagus 3.9%; generally normal cardia 61.4%, short segment hiatus hernia 20.4%, and long segment hiatal hernia 18.2%. The detection rates of esophagitis showed statistically significant differences () between the three groups of generally normal cardia, short segment hiatal hernia and long segment hiatal hernia; The detection rate of Barrett esophagus was significantly higher in long segment hiatal hernia group than in generally normal cardia group and short segment hiatal hernia group (, P=0.012), but the difference between the later two groups was not statistically significant (P>0.013). Comparing the three age groups of 18-39, and 60 years old, the detection rate of hiatal hernia was significantly higher in the group of 60 years old than in the and years old groups (P=0.007), while there was no significant difference (P>0.013) between the and years old groups. The detection rate of esophagitis was significantly higher in 60 years old group than in and years old groups (P=0.004, P=0.008), while no significant statistically difference (P>0.013) was found between the later two groups. Conclusions Gastroscopy can be used as a basic examination means for GERD; short segment hiatal hernia can be regarded as an early form of hiatal hernia, and is of important [ ] (Z ) [ ] [ ] ( ) ( ) [ ] drjiminwu@126.com

2 Med J Chin PLA, Vol. 43, No. 1, January 1, reference value for the diagnosis and treatment of GERD; more serious hiatal hernia and esophagitis could be found in elderly GERD patients. [Key words] gastroesophageal reflux disease; gastroscopy; hernia, hiatal; esophagitis; Barrett esophagus (gastroesophageal reflux disease GERD) ( ) ( ) ( ) GERD [1-2] GERD( ) 18.1%~27.8% 23.0% 8.8%~25.9% 8.7%~33.1% 11.6% [3] GERD (3.9%~25.5%) [4] GERD [5] GERD GERD Barrett (Barrett esophagus BE) (hiatal hernia HH) GERD GERD GERD 18 [ ( ) ] GERD GERD 3 ( ) GERD 2d 1d ( ) (proton pump inhibitor PPI) 1.2 (Fujinon System 4400/EG-590WR) GERD GERD (gastroesophageal junction GEJ) (Los Angeles classification LA) (non-erosive GERD NERD) LA-A 1 1 5mm LA-B 1 1 5mm LA-C <75% LA-D 75% ( 1) BE ( ) BE(<1cm) BE(1~3cm) BE( 3cm) HH ( crural diaphragm CD) 0.5cm 0.5~2.0cm HH 2.0cm HH( 1) HH ( ) ( ) ( ) HH 1min 1.3 SPSS 13.0 χ 2 P<0.05 P< ~89( ) 18~ (22.1%) 40~ (51.8%) (26.1%) NERD 3217 (78.7%) 869 (21.3%) LA-A 365 (8.9%) LA-B 354 (8.7%) LA-C 99 (2.4%) LA-D 51 (1.2%) BE 3585 (87.7%) BE 338 (8.3%) BE 155 (3.8%) BE 8 (0.2%) 2509 (61.4%) HH

40 2018 1 1 43 1 1 2 3 4 5 A B C 1 HH Fig. 1 The manifestations of esophagitis and hiatus hernia under general gastroscope A1. Normal esophageal mucosa; A2-A5. Esophagitis LA-A - LA-D; B1, C1.

3 A B C 1 HH Fig. 1 The manifestations of esophagitis and hiatus hernia under general gastroscope A1. Normal esophageal mucosa; A2-A5. Esophagitis LA-A - LA-D; B1, C1. The frontal and reversal view of normal cardia under gastroscope; B2, C2. Short segment HH, upward displacement of gastroesophageal junction for 0.5-2cm; B3, C3. Long segment HH, upward displacement of gastroesophageal junction for 2cm; B4, C4. Paravertebral HH, only the HH into the chest; B5, C5. Mixed HH, both of esophageal and gastric HH into the chest 1577 (38.6%) HH 832 (20.4%) HH 745 (18.2%) 4 (0.1%) 37 (0.9%) 5 (0.1%) GERD 15 (0.4%) 8 (0.2%) 7 (0.2%) 884 (21.6%) 43 (1.1%) 38 (0.9%) HH HH () ( 1 2A) HH BE HH ( P <0.001 P =0.012) (P= B) LA-B HH NERD LA-A LA-A HH NERD ( 2C) 60 HH 1 HH HH [ (%)] Tab. 1 Comparison of detection rate of esophagitis of different severity in patients with generally normal cardia, short segment hiatal hernia (HH) and long segment HH under gastroscope [n(%)] Cardia morphology NERD LA-A LA-B LA-C LA-D Total Generally normal cardia 2239(89.2) 173(6.9) 84(3.3) 8(0.3) 5(0.2) 2509(100) Short segment HH (1) 632(76.0) 98(11.8) 84(10.1) 11(1.3) 7(0.8) 832(100) Long segment HH (1)(2) 346(46.4) 94(12.6) 186(25.0) 80(10.7) 39(5.2) 745(100) Total 3217(78.7) 365(8.9) 354(8.7) 99(2.4) 51(1.2) 4086(100) NERD. Non-erosive reflux disease. (1) compared with generally normal cardia; (2) compared with short segment HH 2 HH HH BE [ (%)] Tab. 2 Comparison of detection rates of BE in patients with generally normal cardia, short segment hiatal hernia (HH) and long segment HH under gastroscope [n(%)] Cardia morphology Non BE Suspected BE BE Total Generally normal cardia 2216(88.3) 209(8.3) 84(3.3) 2509(100) Short segment HH 736(88.5) 67(8.1) 29(3.5) 832(100) Long segment HH 633(85.0) 62(8.3) 50(6.7) (1)(2) 745(100) Total 3585(87.7) 338(8.3) 163(4.0) 4086(100) BE. Barrett esophagus. (1) compared with generally normal cardia; (2)P=0.012 compared with short segment HH 40~59 (P=0.007) 18~39 40~59 60 (P>0.013) 60 18~39 40~59 (P= ) 18~39 40~59 (P> ) BE (P 0.013) 3 GERD ( PPI)

Med J Chin PLA, Vol. 43, No. 1, January 1, 2018 41 Severity of esophagitis 3000 2500 2000 1500 1000 500 0 Generally normal cardia LA-D BE 3000 LA-C 3000 P=0.

4 Med J Chin PLA, Vol. 43, No. 1, January 1, Severity of esophagitis Generally normal cardia LA-D BE 3000 LA-C 3000 P=0.954 Suspected BE 2500 LA-B 2500 Non-BE LA-A NERD P= Short Long Generally Short Long NERD LA-A LA-B segment segment normal segment segment HH HH A cardia HH HH B C 2 BE Fig. 2 The relationship between cardia morphology and esophagitis and BE under gastroscope Severity of BE A. Comparison of detection rate of esophagitis in generally normal cardia, short segment HH and long segment HH; B. Comparison of detection rate of BE in generally normal cardia, short segment HH and long segment HH. C. Comparison of detection rate of HH in NERD, LA-A and LA-B Cardia morphology Long segment HH Short segment HH Generally normal cardia 3 HH [ (%)] Tab. 3 Comparison of esophagitis and HH detection rate in different age groups [n(%)] Age (year) NERD Esophagitis Esophagitis Cardia morphology Generally normal cardia HH (80.8) 173(19.2) 538(59.7) 363(40.3) (79.5) 433(20.5) 1348(63.7) 769(36.3) (75.4) 263(24.6) (1)(3) 623(58.3) 445(41.7) (2) Total 3217(78.7) 869(21.3) 2509(61.4) 1577(38.6) NERD. Non-erosive reflux disease. (1)P=0.004, (2)P=0.007 compared with18-39 years group; (3)P=0.008 compared with years group GERD PPI GERD ( ) 6 42%~68% GERD [6] LA GERD LA-B GERD LA-A [7] GERD 50% [8] 30%~76% 62%~96% [9] 21.3% LA-B 8.7% (LA-C LA-D) 3.6% 0.6% GERD 30% [10] BE [11] BE [12] [13] 1cm [14] BE C&M 1cm BE 0.72 <1cm 0.22 [15-16] <1cm BE <1cm BE BE BE BE 0.9%~4.5% GERD BE 10%~15% [17] GERD BE GERD BE 8.3% BE 3.7% BE 0.2% GERD BE (1.6% vs. 37.1%) [18] <1cm BE ( 68.0%) BE [19] BE GERD GERD HH 50%~90% GERD HH GERD HH HH ( ) ( ) GERD ( ph ) HH HH Hyun [20] HH(GEJ 0.5~2.0cm HH) BE 2cm HH( HH) 20.4% >2cm HH 18.2% HH 38.6% HH HH

5 HH HH BE HH HH ( ) ( ) His ( ) [21] HH HH GERD BE HH [22-24] HH GERD [25] HH GERD HH GERD ( ) [26-27] HH GERD HH [28] HH HH BE [29] BE HH [30] HH BE [31] HH (LA-C LA-D) HH 91.3%( 13.1% HH 86.9% HH) HH PPI PPI GERD HH [32] 476 HH % [27] ( GEJ-CD 2cm HH) HH HH(GEJ-CD 2cm) HH GERD HH GERD ( ) GEJ-CD 2cm HH GEJ-CD >2cm HH GERD GERD 95% HH HH [33] HH 97% HH HH [34] 40~60 (51.8%) GERD 60 HH GERD 50 BE [35] GERD ( HH ) ( ) ( ) GERD [36] 21.6% GERD BE [37-38] PPI ( ) [39] 1.1% 0.9% GERD ( ) BE HH GERD GERD GEJ-CD 2cm HH GEJ-CD >2cm HH HH HH GERD 60 GERD 60 GERD

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