Frequent Upper Gastrointestinal Symptoms in Japanese Females Compared to Males Did Not Depend on Endoscopic Esophagitis: 387

Introduction: Upper gastrointestinal symptoms are common in both Western countries and Japan. This study was performed to i) clarify the factors associated with high scores on the modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) among 3,505 relatively healthy subjects undergoing routine medical health checkups with gastrointestinal endoscopy and ii) compare risk factors for high FSSG scores between subjects with and without reflux esophagitis. Methods: In total, 3,505 subjects (male/female: 1922/1583) who underwent upper gastrointestinal endoscopy during medical health checkups at 5 hospitals in Saga, Japan from January 2013 to December 2013 were enrolled. All subjects completed a modified FSSG questionnaire, which comprised seven questions regarding reflux symptoms and seven questions regarding acid-related dyspepsia. Results: Endoscopic reflux esophagitis was detected in 395 subjects (11.3%), and most esophagitis was not severe (grade A, n=329; grade B, n=63; grade C, n=3; grade D, n=0). Hiatal herniation and Barrett's esophagus were present in 1,196 (34.1%) and 940 (26.8%) subjects, respectively, and most cases of Barrett's esophagus were short-segment (928/940). Gastric and duodenal ulcers were not common. Of all 3,505 subjects, 1,030 (29.3%) were infected with Helicobacter pylori at the time of their medical health checkup, and H. pylori had already been eradicated in 540 subjects (15.4%). A high FSSG score of ≥6 points was detected in 919 subjects (26.2%). Multivariate analysis indicated that the risk factors for a high FSSG score were young age (P<0.001), female sex (P<0.001), hiatal hernia (P=0.02), and endoscopic esophagitis (P<0.001). Other factors, including Barrett's esophagus, eradication of H. pylori infection, and peptic ulcers, were not related to a high FSSG score. The highscoring subjects with and without esophagitis were compared with each other. Multivariate analysis indicated that the only risk factor for a high FSSG score in subjects without esophagitis was female sex (P<0.001); hiatal herniation and Barrett's esophagus were observed with high frequency in subjects with reflux esophagitis. Conclusion: Younger age, female sex, hiatal hernia, and endoscopic esophagitis were risk factors for a high FSSG score. Healthy Japanese females complained upper gastrointestinal symptoms more frequently than males regardless endoscopic esophagitis.