Association between atrophic gastritis and gastroesophageal reflux symptoms

Background/Aims: Atrophic gastritis may be inversely associated with gastroesophageal reflux disease (GERD) symptoms. The aim of this study was to determine the association between GERD symptoms, endoscopic atrophy grade, and histologic atrophy score. Methodology: A total of 1,555 consecutive subjects who underwent esophagogastroduodenoscopy for health check-ups were enrolled prospectively. All persons were given a self-reported questionnaire for GERD symptoms (heartburn and/or regurgitation) and were classified into the following two groups: GERD symptoms group and no GERD symptoms group. Endoscopic grade of atrophic gastritis was assessed by the atrophic pattern system. The histologic atrophy score was evaluated semi-quantitatively by the updated Sydney classification. Results: Of the 1,555 patients, 314 (20.2%) had GERD symptoms at least once a week and 1,241 (79.8%) had no GERD symptoms. The prevalence of the O-type atrophic gastritis (4.1% vs. 8.9%) and moderate or severe atrophic gastritis (1.9% vs. 4.8%) was significantly lower in the GERD symptoms group (p <0.05). The association between GERD symptoms and moderate or severe atrophic gastritis persisted after adjustment for potential confounders (p = 0.012). Of the 304 subjects who underwent endoscopic biopsies, 57 (18.8%) and 247 (81.2%) were in the GERD symptoms and no symptoms groups, respectively. There were no significant differences in H. pylori infections, H. pylori density, neutrophil activity, and degree of inflammation between the two groups. However, the scores of intestinal metaplasia and glandular atrophy were significantly lower in the GERD symptoms group (p <0.05). Conclusions: GERD symptoms are inversely associated with the endoscopic atrophy grade and the histologic atrophy score.