Endoscopic findings around the gastroesophageal junction: an experience from a tertiary hospital in Korea

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.