Prevalence of Upper Gastrointestinal Diseases in Korea Military Pilots Aged Over 40 Years: A Screening Endoscopy-Based Study

Purpose: This study investigated the prevalence of upper gastrointestinal (GI) diseases among Korea military pilots aged over 40 years using screening upper GI endoscopy, with the aim of providing foundational data to inform aviation medicine policies.Methods: We retrospectively reviewed medical records of 198 military pilots aged over 40 years who underwent routine screening upper GI endoscopy at the Korean Air Force Aerospace Medical Center between January 2020 and December 2023.Endoscopic findings, histopathological results, and Helicobacter pylori infection rates were analyzed.Results: Erosive reflux esophagitis was identified in 13.1% of pilots (26/198), with the majority classified as mild (Los Angeles grade A or B); concomitant hiatal hernia was present in 4.0% (8/198).Endoscopic biopsies were performed in 28.3% of cases (56/198).Histopathological analysis confirmed gastric adenoma-a recognized precancerous lesion-in 1.0% (2/198) and fundic gland polyps in 1.5% (3/198).Among the 80 pilots who underwent H. pylori testing, the infection rate was 42.5% (34/80).Conclusion: Despite rigorous medical selection criteria and ongoing health surveillance, military pilots demonstrated a meaningful burden of upper GI pathology, including erosive esophagitis, precancerous gastric lesions, and H. pylori infection.Given that acute GI complications-such as massive hemorrhage or perforation-can precipitate sudden in-flight incapacitation with potentially catastrophic consequences for flight safety, the establishment of standardized endoscopic surveillance protocols and proactive treatment guidelines tailored to the unique physiological demands of the aviation environment is strongly warranted.