Advertisement

Risk of Esophagitis Among Individuals Born Preterm or Small for Gestational Age

Published:September 17, 2012DOI:https://doi.org/10.1016/j.cgh.2012.09.014

      Background & Aims

      The association between gastroesophageal reflux and esophageal adenocarcinoma is likely to be mediated by inflammation. Reflux is common in infancy; the esophageal mucosa of infants born preterm or small for gestational age (SGA) could be particularly vulnerable. We investigated the association between preterm or SGA birth and risk of esophagitis early in life.

      Methods

      We analyzed data from the Swedish birth register and the Swedish patient register to identify birth characteristics of individuals with endoscopically verified esophagitis from 1973 to 2007 and to determine their outcomes (7358 cases). Five controls were selected randomly and matched with each case (N = 38,479). Multivariable conditional logistic regression models were used to provide odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounding.

      Results

      The risk of esophagitis was increased among individuals born preterm (≤32 gestational weeks) (OR, 2.74; 95% CI, 2.15–3.49) or SGA (OR, 1.49; 95% CI, 1.32–1.68). When data were stratified by age at diagnosis and by sex, different risk patterns appeared. Among individuals diagnosed with esophagitis 9 years of age and younger, the OR for prematurity was 6.82 (95% CI, 4.65–10.03) and the OR for SGA at birth was 1.98 (95% CI, 1.55–2.52). Furthermore, the association with preterm birth was stronger among males (OR, 9.88; 95%, CI 5.93–16.45) than females (OR, 3.41; 95% CI, 1.81–6.41), whereas the association with SGA was stronger among females (OR, 2.50; 95% CI, 1.76–3.55) than males (OR, 1.64; 95% CI, 1.16–2.30). The risk of being diagnosed with esophagitis at age 20 or younger was not associated with preterm birth (OR, 1.02; 95% CI, 0.64–1.63), but was associated with being SGA at birth (OR, 1.31; 95% CI, 1.11–1.54).

      Conclusions

      Preterm birth is associated with esophagitis only during childhood, whereas SGA birth is associated with esophagitis during adolescence as well. The associations appear to differ between sexes.

      Keywords

      Abbreviations used in this paper:

      BMI (body mass index), CI (confidence interval), GERD (gastroesophageal reflux disease), ICD (International Classification of Diseases), OR (odds ratio), SGA (small for gestational age)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vakil N.
        • van Zanten S.V.
        • Kahrilas P.
        • et al.
        The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.
        Am J Gastroenterol. 2006; 101 (quiz, 1943): 1900-1920
        • Romero Y.
        • Cameron A.J.
        • Locke 3rd, G.R.
        • et al.
        Familial aggregation of gastroesophageal reflux in patients with Barrett's esophagus and esophageal adenocarcinoma.
        Gastroenterology. 1997; 113: 1449-1456
        • Klauser A.G.
        • Schindlbeck N.E.
        • Müller-Lissner S.A.
        Symptoms in gastro-oesophageal reflux disease.
        Lancet. 1990; 335: 205-208
        • Ghillebert G.
        • Demeyere A.M.
        • Janssens J.
        • et al.
        How well can quantitative 24-hour intraesophageal pH monitoring distinguish various degrees of reflux disease?.
        Dig Dis Sci. 1995; 40: 1317-1324
        • Winters Jr, C.
        • Spurling T.J.
        • Chobanian S.J.
        • et al.
        Barrett's esophagus.
        Gastroenterology. 1987; 92: 118-124
        • Kahrilas P.J.
        Clinical practice.
        N Engl J Med. 2008; 359: 1700-1707
        • Lagergren J.
        • Bergström R.
        • Lindgren A.
        • et al.
        Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
        N Engl J Med. 1999; 340: 825-831
        • Gold B.D.
        Is gastroesophageal reflux disease really a life-long disease: do babies who regurgitate grow up to be adults with GERD complications?.
        Am J Gastroenterol. 2006; 101: 641-644
        • El-Serag H.B.
        • Gilger M.
        • Carter J.
        • et al.
        Childhood GERD is a risk factor for GERD in adolescents and young adults.
        Am J Gastroenterol. 2004; 99: 806-812
        • Martin A.J.
        • Pratt N.
        • Kennedy J.D.
        • et al.
        Natural history and familial relationships of infant spilling to 9 years of age.
        Pediatrics. 2002; 109: 1061-1067
        • El-Serag H.B.
        • Richardson P.
        • Pilgrim P.
        • et al.
        Determinants of gastroesophageal reflux disease in adults with a history of childhood gastroesophageal reflux disease.
        Clin Gastroenterol Hepatol. 2007; 5: 696-701
        • Chadwick L.M.
        • Kurinczuk J.J.
        • Hallam L.A.
        • et al.
        Clinical and endoscopic predictors of histological oesophagitis in infants.
        J Paediatr Child Health. 1997; 33: 388-393
        • Black D.D.
        • Haggitt R.C.
        • Orenstein S.R.
        • et al.
        Esophagitis in infants.
        Gastroenterology. 1990; 98: 1408-1414
        • Kaijser M.
        • Akre O.
        • Cnattingius S.
        • et al.
        Preterm birth, low birth weight, and risk for esophageal adenocarcinoma.
        Gastroenterology. 2005; 128: 607-609
        • Akre O.
        • Forssell L.
        • Kaijser M.
        • et al.
        Perinatal risk factors for cancer of the esophagus and gastric cardia: a nested case-control study.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 867-871
        • Dhillon A.S.
        • Ewer A.K.
        Diagnosis and management of gastro-oesophageal reflux in preterm infants in neonatal intensive care units.
        Acta Paediatr. 2004; 93: 88-93
        • Kase J.S.
        • Pici M.
        • Visintainer P.
        Risks for common medical conditions experienced by former preterm infants during toddler years.
        J Perinat Med. 2009; 37: 103-108
        • Altman M.
        • Vanpée M.
        • Cnattingius S.
        • et al.
        Neonatal morbidity in moderately preterm infants: a Swedish national population-based study.
        J Pediatr. 2011; 158: 239-244.e1
        • National Board of Health and Welfare
        Centre for Epidemiology.
        2003 (Stockholm, Sweden)
        • Armstrong D.
        • Bennett J.R.
        • Blum A.L.
        • et al.
        The endoscopic assessment of esophagitis: a progress report on observer agreement.
        Gastroenterology. 1996; 111: 85-92
        • Lundell L.R.
        • Dent J.
        • Bennett J.R.
        • et al.
        Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification.
        Gut. 1999; 45: 172-180
        • Marsál K.
        • Persson P.H.
        • Larsen T.
        • et al.
        Intrauterine growth curves based on ultrasonically estimated foetal weights.
        Acta Paediatr. 1996; 85: 843-848
        • Høgberg U.
        • Larsson N.
        Early dating by ultrasound and perinatal outcome.
        Acta Obstet Gynecol Scand. 1997; 76: 907-912
        • Orenstein S.R.
        • Shalaby T.M.
        • Kelsey S.F.
        • et al.
        Natural history of infant reflux esophagitis: symptoms and morphometric histology during one year without pharmacotherapy.
        Am J Gastroenterol. 2006; 101: 628-640
        • Reyes A.L.
        • Cash A.J.
        • Green S.H.
        • et al.
        Gastroesophageal reflux in children with cerebral palsy.
        Child Care Health Dev. 1993; 19: 109-118
        • Gangil A.
        • Patwari A.K.
        • Bajaj P.
        • et al.
        Gastroesophageal reflux disease in children with cerebral palsy.
        Indian Pediatr. 2001; 38: 766-770
        • Lorenz J.M.
        The outcome of extreme prematurity.
        Semin Perinatol. 2001; 25: 348-359
        • Himmelmann K.
        • Hagberg G.
        • Beckung E.
        • et al.
        The changing panorama of cerebral palsy in Sweden.
        Acta Paediatr. 2005; 94: 287-294
        • Vizcaino A.P.
        • Moreno V.
        • Lambert R.
        • et al.
        Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973–1995.
        Int J Cancer. 2002; 99: 860-868
        • Persson S.
        • Ekbom A.
        • Granath F.
        • et al.
        Parallel incidences of sudden infant death syndrome and infantile hypertrophic pyloric stenosis: a common cause?.
        Pediatrics. 2001; 108: E70