Gastroesophageal reflux disease in an urban population in Turkey: A model of a developing nation with high H. pylori prevalence

and the cardia, and to evaluate the association with reflux symptoms.Methods: A random sample (n = 1200) of the population (18-80 years, mean age 50 years, 50% female) of two Swedish municipalities, Kalix and Haparanda (n = 28 000), were surveyed using a validated questionnaire assessing esophageal, abdominal and bowel symptoms (response rate 72%).One-third of the surveyed population was invited for esophagogastroduodenoscopy (EGD) (83% participation rate).Esophageal mucosal breaks were graded according to the Los Angeles classification system.Two biopsy specimens each from the cardia, the z-line and 2 cm above the z-line were obtained.Results: EGD was performed in 394 subjects.The esophagus was macroscopically normal in 320 subjects (81.2%), 45 (11.4%) had esophagitis Los Angeles A-D and 29 (7.4%) had red tongues indicative of Barrstt's esophagus.152 subjects (38.6%) reported reflux symptoms during the past three months.At the z-line only 7 subjects (1.8%) showed SIM (none of these had a red tongue). 2 cm above the z-line no subject showed SIM.None had dysplasia.In the cardia, histology showed SIM in 8 subjects (2.0%), while 21 (5.3%) had complete hut not specialized intestinal metaplasia.Of the subjects with specialized intestinal metaplasia in the esophagus or cardia, endoscopic esophagitis was found in 26.7 % (p=O.09), and 46.7 % had reflux symptoms (p=O.5).Conclusions: The prevalence of reflux associated esophageal changes in the general population is high, but short segment Barrett defined macroscopically or histologically is rare.Specialized intestinal metaplasia was also found in subjects without reflux symptoms, and in subjects without macroscopical esophagitis.