Symptoms of Reflux Esophagitis and Nursing Staffs 231 Table 1. Analysis evaluated by χ2 test of the relationship between several factors in endoscopy-positive subjects Factors Sex (males/females) Age (30/40/50/60/70/80 years) BMI (<25:25≤) Hiatus hernia (+/−) Smoking (+/−) Alcohol drinking (+/−) Grade (A:B:C:D) Group I (n = 539) 270/269 46/103/97/129/117/47 369:142 279/260 176/363 231/308 271:187:58:23 Group II (n = 465) 276/189 38/79/83/113/109/43 356:82 186/279 170/295 202/263 332:100:26:7 p value 0.003 0.955 0.001 <0.001 0.194 0.852 <0.001 Group I: endoscopic esophagitis with heartburn. Group II: endoscopic esophagitis without any symptoms. Grade: evaluation of reflux esophagitis with Los Angles Classification [2]. BMI: body mass index (kg/m2) Table 2. Univariate analysis evaluated between Groups I and II Table 3. Multivariate analysis evaluated between Groups I and II Factors Sex (males/females) BMI <25 BMI 25≤ Hiatus hernia (+/−) Esophagitis: grades A + B Esophagitis: grades C + D OR 1.46** 1 0.60** 0.62** 1 0.43** 95% CI 0.54–0.88 reference 0.44–0.82 0.48–0.80 reference 0.28–0.66 Factors Sex (males/females) BMI <25 BMI 25≤ Hiatus hernia (+/−) Esophagitis: grades A + B Esophagitis: grades C + D OR 1.35* 1 0.62** 0.69** 1 0.45** 95% CI 0.57–0.98 reference 0.45–0.84 0.53–0.90 reference 0.29–0.72 **p<0.01. OR was adjusted for each symptom, age and sex. Group I: endoscopic esophagitis with heartburn. Group II: endoscopic esophagitis without any symptoms. BMI: body mass index (kg/m2). *p<0.05, **p<0.01. OR was adjusted for each symptom, age and sex. Group I: endoscopic esophagitis with heartburn. Group II: endoscopic esophagitis without any symptoms. BMI: body mass index (kg/m2). Discussion In the present study, we evaluated endoscopy-positive patients who did not complain of symptoms by brief questions by nursing staffs, as in our previous studies [8, 18], and who had not been given medication for gastrointestinal disease. Precise and structured questionnaires for reflux symptoms are useful for diagnosis of gastroesophageal reflux disease, and heartburn is a major and specific symptom that is associated with abnormal manometric and pH results [19–25]. It has also been shown that a brief and simple questionnaire is reliable for noting changes in reflux symptoms [10, 26]. We did not use precise question- naires in this study, because the aim was to establish whether patients who suffered from reflux symptoms in daily life could be detected by brief questioning by nursing staffs. This consisted of briefly asking the patients about heartburn, dysphagia, odynophagia and acid regurgitation before endoscopic examination, and the patients simply answered “yes” or “no”. The present study focused on patients with endoscopy- positive reflux esophagitis without clinical symptoms, assessed by brief questioning by nursing staffs. The number of endoscopy-positive patients who did not complain of any Vol. 46, No. 3, 2010 symptoms was ~6% (465/8031) of the whole group tested. The ratio of patients without symptoms among those with endoscopic esophagitis was relatively high, 465/1199 (38.8%). This high ratio was partly due to the specific conditions of the present study. The patients surveyed were limited to outpatients who did not receive medication for gastrointestinal disease. The patients were selected from those receiving secondary examinations from a primary gastroenterological mass survey conducted in Saga Prefec- ture, and the patients visited the hospital for a routine physical examination. The level of severe esophagitis in this study was low, around 2%. The nursing staffs asked patients brief questions, and patients simply answered “yes” or “no”. The cross-sectional study with a large subject population indicated that the characteristics of patients with endoscopic esophagitis without any clinical symptoms were male gender, absence of obesity and hiatus hernia, and low-grade esophagitis, compared to patients with endoscopic eso- phagitis with heartburn. We performed a large number of routine endoscopic examinations, because upper gastro- intestinal endoscopy is an examination routinely performed once a year in Japan due to the high prevalence of gastric cancer and squamous cell cancer of the esophagus. As a