Increasing trend of reflux esophagitis and decreasing trend of Helicobacter pylori infection in patients from a multiethnic Asian country

OBJECTIVES: This study aimed to determine time trends in the frequency of endoscopic esophagitis, and Helicobacter pylori (H. pylori) infection in a large Singaporean teaching hospital over a 10-yr period. METHODS: We studied a consecutive series of 16,375 patients who had been newly referred for diagnostic esophagogastroduodenoscopy from 1992 to 2001. All endoscopic findings were prospectively recorded. From 1995, an antral biopsy was taken from 6,185 unselected patients for an in-house biopsy urease test. Endoscopic esophagitis was defined as the presence of erosions and/or ulceration. The relationship between erosive esophagitis and various relevant factors was analyzed. RESULTS: The overall prevalence of endoscopic esophagitis was 6.9% (95% Cl, 6.5-7.3). It was 7.3% (95% Cl, 6.2-8.4) in patients with a positive urease test, and 9.0% (95% Cl, 8.1-9.9) in those in whom the urease test was negative (p < 0.001). From 1992 to 2001, the frequency of endoscopic esophagitis increased (p < 0.001 for trend) while that of positive urease test decreased from 1995 to 2001 (p < 0.001 for trend). The increase in the prevalence of endoscopic esophagitis (RR 1.99, 95% Cl 1.18-3.36, p = 0.0098), and its inverse relationship with positive urease test results (RR 0.991, 95% CI 0.983-0.999, p = 0.049) remained significant even after adjusting for age, gender, ethnic distribution, and hiatal hernia. CONCLUSIONS: The frequency of endoscopic esophagitis increased in Singapore from 1992 to 2001. This increase within a short period of time suggests that environmental factors, of which the decreasing rate of H. pylori infection may be one, are important in the pathogenesis of gastroesophageal reflux disease.