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[Introduction] The impairment of lower esophageal sphincter (LES) function palys a pathogenic role in reflux esophagitis. Obesity or high fat diet are also known to be exacerbating factors. On the other hand, Helicobacter pylori (H. pylori) infection and gastric atrophy may playa protective role for reflux esophagitis. We tried to evaluate the effect of these factors in a cross-sectional study of a large population by using a multivariate analysis. Methods: We conducted gastro-intestinal endoscopy to and obtained blood sample from 4,249 of Japanese (male/female = 2,73611,513, mean age = 46.9 ± 8.2) during our general health appraisal. A total of 90 cases of reflux esophagitis were found. We evaluated the parameters of gender, age, and as follows: body mass index (body weight (kg) / body length (m)2) as an indicator of obesity, serum triglyceride (rng/dl) as an indicator of fat intake, serum pepsinogen IIII ratio (pepsinogen I (ng/ml) / pepsinogen II (ng/ml) as an indicator of gastric atrophy induced by H. pylori, and hiatal herniation as an indicator of LES function. We applied univariate and murtivariate analyses by using logistic regression models. Results: In univariate analyses, all the evaluated parameters but age were statistically significant. Male gender, higher body mass index, higher serum triglyceride, higher pepsinogen IIII ratio (=indicating milder gastric atrophy), and the existence of hiatal herniation were positively associated with reflux esophagitis. However, in a multivariate analysis, older age [by ten years: p=0.03, OR(95%CI) = 1.3(1.03-1.7)], higher pepsinogen IJII ratio (=indieating milder gastric atrophy) [>3.0 vs