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Witarto AP, Witarto BS, Pramudito SL, Ratri LC, Wairooy NAP, Konstantin T, Putra AJE, Wungu CDK, Mufida AZ, Gusnanto A. Risk factors and 26-years worldwide prevalence of endoscopic erosive esophagitis from 1997 to 2022: a meta-analysis. Sci Rep 2023; 13:15249. [PMID: 37709957 PMCID: PMC10502104 DOI: 10.1038/s41598-023-42636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Abstract
Erosive esophagitis (EE) is the part of gastroesophageal reflux disease (GERD) spectrum and may progress to esophageal adenocarcinoma. Due to its progressivity and unclear prevalence, we aim to identify the factors contributing in EE to decide the need for further examination. We performed a PRISMA 2020-based systematic search through PubMed and other resources up to June 2, 2022. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The odds ratio (OR) of each factor and worldwide prevalence of EE were measured. There are 114 observational studies included with a total of 759,100 participants. Out of 29 factors, the significant risk factors are age ≥ 60 y.o. (OR 2.03 [1.81-2.28]), White/Caucasian (OR 1.67 [1.40-1.99]), unmarried (OR 1.08 [1.03-1.14]), having GERD ≥ 5 years (OR 1.27 [1.14-1.42]), general obesity (OR 1.78 [1.61-1.98]), central obesity (OR 1.29 [1.18-1.42]), diabetes mellitus (DM) (OR 1.24 [1.17-1.32]), hypertension (OR 1.16 [1.09-1.23]), dyslipidemia (OR 1.15 [1.06-1.24]), hypertriglyceridemia (OR 1.42 [1.29-1.57]), hiatal hernia (HH) (OR 4.07 [3.21-5.17]), and non-alcoholic fatty liver disease (NAFLD) (OR 1.26 [1.18-1.34]). However, H. pylori infection (OR 0.56 [0.48-0.66]) and atrophic gastritis (OR 0.51 [0.31-0.86]) are protective towards EE. This study demonstrates that age, ethnicity, unmarried, long-term GERD, metabolic diseases, HH, and NAFLD act as risk factors for EE, whereas H. pylori infection and atrophic gastritis act as protective factors. These findings may enable a better understanding of EE and increase greater awareness to address its growing burden.
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Affiliation(s)
| | | | | | | | | | - Tiffany Konstantin
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya, 60132, Indonesia.
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
| | - Annisa Zahra Mufida
- Department of Internal Medicine, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Universitas Airlangga Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Zhan J, Yuan M, Zhao Y, Zhang X, Qiao T, Ji T, Gao H, Cao Z, Wang D, Ding N. Abdominal obesity increases the risk of reflux esophagitis: a systematic review and meta-analysis. Scand J Gastroenterol 2022; 57:131-142. [PMID: 34738858 DOI: 10.1080/00365521.2021.1994643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The association between abdominal obesity and reflux esophagitis (RE) has been extensively evaluated, but the current findings are mixed and more convincing epidemiological evidence urgently needs to be established. To thoroughly explore this relationship, we summarized the latest studies, performed an updated meta-analysis, and examined the dose-response relationship. METHODS We performed a systematic search of PubMed, Web of Science, and Embase up to 28 March 2021, using prespecified terms to identify studies investigating the association between abdominal obesity and RE. Odds ratios (ORs) with 95% confidence intervals (CIs), mean differences (MDs) or standardized mean differences (SMDs) with 95% CIs were taken as effect-size estimates. RESULTS Forty-two observational studies, including 11 cohort studies, were meta-analyzed. Overall, a statistically significant association was observed between abdominal obesity and RE, by both the pooled OR (adjusted OR = 1.51, 95% CI: 1.37-1.66, p < .001) and the pooled SMD (SMD = 0.36, 95% CI: 0.30-0.42, p < .001). Moreover, this significant relationship persisted with subgroup stratification. In subgroup analyses, we found that study design, abdominal obesity measurement, adjustment for covariates and sex were possible sources of between-study heterogeneity. For the dose-response analyses, the risk of RE increased with the degree of abdominal obesity, and the increasing trend accelerated when waist circumference (WC) reached 87.0 cm. CONCLUSION This meta-analysis indicated a significant association between abdominal obesity and RE, and the risk of RE increased with abdominal obesity especially when the WC was over 87.0 cm.
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Affiliation(s)
- Junyi Zhan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Mengqi Yuan
- Department of Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Yujie Zhao
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xin Zhang
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tianci Qiao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianshu Ji
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hui Gao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhiqun Cao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongli Wang
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nan Ding
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Osaga S, Nakada K, Iwakiri K, Haruma K, Joh T, Kamiya T. Sex differences in risk factors for future onset of reflux esophagitis. J Clin Biochem Nutr 2021; 69:91-97. [PMID: 34376918 PMCID: PMC8325768 DOI: 10.3164/jcbn.20-202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/25/2020] [Indexed: 11/25/2022] Open
Abstract
Reflux esophagitis is known to be more prevalent in males, and previous studies have suggested sex differences in its risk factors. However, little is known about sex differences in the time-course of risk factors before reflux esophagitis onset. Thus, we conducted a retrospective longitudinal study using health checkup records. From the records of 230,056 individuals obtained from nine institutes in Japan, we selected 1,558 male reflux esophagitis cases, 3,116 male controls, 508 female reflux esophagitis cases, and 1,016 female controls were selected. We compared time-courses of risk factors between the case and control groups and identified abdominal circumference (AC), diastolic blood pressure, alanine transaminase (ALT), and current smoking in males and body mass index (BMI) in females as sex-specific risk factors. We also found that AC and ALT in males and BMI in females were significantly different between the reflux esophagitis case and control groups during the five years before reflux esophagitis onset. Our results suggest that visceral fat-type obesity and fatty liver in males and higher BMI in females are more frequently observed in reflux esophagitis cases several years before reflux esophagitis onset, and that proactive intervention to lifestyle can help prevent reflux esophagitis in both males and females.
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Affiliation(s)
- Satoshi Osaga
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Okayama 700-8505, Japan
| | - Takashi Joh
- Gamagori City Hospital, Gamagori, Aichi 443-8501, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Yang HJ, Chang Y, Park SK, Jung YS, Park JH, Park DI, Ryu S, Sohn CI. Sex Differences in the Relation between Waist Circumference within the Normal Range and Development of Reflux Esophagitis. J Clin Med 2019; 8:jcm8010067. [PMID: 30634537 PMCID: PMC6352112 DOI: 10.3390/jcm8010067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 01/15/2023] Open
Abstract
We examined the association of abdominal obesity and waist circumference within normal range with the incidence of reflux esophagitis, separately in men and women. This cohort study involved 142,679 Korean adults without reflux esophagitis, who underwent upper endoscopy at baseline and during follow-up. Waist circumference was categorized into the following quartiles: <80, 80.1⁻85, 85.1⁻90, and ≥90.1 cm in men; and <69.3, 69.3⁻74, 74.1⁻79.5, and ≥79.6 cm in women. During the 551,877.8 person-years of follow-up, 29,509 participants developed reflux esophagitis. The association between waist circumference quartiles and risk of reflux esophagitis significantly differed with sex (p for interaction < 0.001). In men, multivariable-adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) comparing waist circumference quartiles 2, 3, and 4 to the lowest quartile were 1.03 (0.99⁻1.07), 1.08 (1.04⁻1.12), and 1.15 (1.10⁻1.19), respectively. In women, HRs (95% CIs) comparing quartiles 1, 2, and 4 to the 3rd quartile were 1.10 (1.04⁻1.17), 1.03 (0.98⁻1.10), and 1.07 (1.01⁻1.13), respectively. In this large cohort with endoscopic follow-up, the risk of reflux esophagitis increased with increasing waist circumference even within the normal range in men, whereas the risk increased with low normal waist circumference or with abdominal obesity in women, indicating a U-shaped association.
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Affiliation(s)
- Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 04514, Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 04514, Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 03181, Korea.
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Effect of abdominal visceral fat on the development of new erosive oesophagitis: a prospective cohort study. Eur J Gastroenterol Hepatol 2017; 29:388-395. [PMID: 27922485 DOI: 10.1097/meg.0000000000000799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Although abdominal visceral fat has been associated with erosive oesophagitis in cross-sectional studies, there are no data that describe its longitudinal effects. We aimed to evaluate the longitudinal effects of abdominal visceral fat on the development of new erosive oesophagitis in patients who did not have erosive oesophagitis at baseline. MATERIALS AND METHODS This was a single-centre prospective study. A total of 1503 participants without erosive oesophagitis at baseline were followed up for 34 months and they underwent oesophagogastroduodenoscopy and computed tomography at both baseline and during follow-up. The longitudinal effects of abdominal visceral fat on the development of new erosive oesophagitis were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS New oesophagitis developed in 83 patients. Compared with the first quartile, the third (OR=3.96, 95% CI: 1.54-10.18) and the fourth (OR=4.67, 95% CI: 1.79-12.23) of baseline visceral fat quartiles, the third (OR=3.03, 95% CI: 1.14-8.04) and the fourth (OR=7.50, 95% CI: 2.92-19.25) follow-up visceral fat quartiles, and the fourth visceral fat change quartile (OR=2.76, 95% CI: 1.47-5.21) were associated with increased development of new erosive oesophagitis, and the P value for each trend was less than 0.001. New erosive oesophagitis was inversely related to the follow-up Helicobacter pylori status and it was associated positively with the presence of a hiatal hernia and smoking during follow-up, but it was not associated with reflux symptoms, the H. pylori status, presence of a hiatal hernia or smoking at baseline. CONCLUSION Higher level of visceral fat at baseline and follow-up visceral fat, and greater changes in the visceral level were associated linearly with the development of new erosive oesophagitis in this longitudinal study.
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Hung WC, Wu JS, Sun ZJ, Lu FH, Yang YC, Chang CJ. Gender differences in the association of non-alcoholic fatty liver disease and metabolic syndrome with erosive oesophagitis: a cross-sectional study in a Taiwanese population. BMJ Open 2016; 6:e013106. [PMID: 27852719 PMCID: PMC5128939 DOI: 10.1136/bmjopen-2016-013106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Although metabolic syndrome correlates with erosive oesophagitis, few studies have examined the association between non-alcoholic fatty liver disease (NAFLD), associated with obesity and insulin resistance as metabolic syndrome, and erosive oesophagitis. The possible gender differences in risk factors of erosive oesophagitis should be considered. This study aimed to determine the concomitant effects of NAFLD and metabolic syndrome on erosive oesophagitis with respect to gender. DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES This cross-sectional study, conducted between January 2000 and August 2009, included 12 090 participants from the health examination center of a tertiary hospital. NAFLD was diagnosed according to ultrasonographic findings after excluding participants with excessive alcohol consumption or other liver diseases. Metabolic syndrome was determined using the revised National Cholesterol Education Program Adult Treatment Panel III criteria. Erosive oesophagitis was defined according to the Los Angeles classification by oesophagogastroduodenoscopy. RESULTS On the basis of the oesophagogastroduodenoscopic findings, the prevalence of erosive oesophagitis was 20.1% (n=1427/7110) and 9.9% (n=477/4842) in males and females, respectively. After adjusting for other variables, metabolic syndrome (OR 1.26; 95% CI 1.09 to 1.45) but not NAFLD (OR 1.14; 95% CI 0.98 to 1.30) significantly correlated with erosive oesophagitis in males, while NAFLD (OR 1.50; 95% CI 1.21 to 1.86) but not metabolic syndrome (OR 1.24; 95% CI 0.94 to 1.63) positively correlated with erosive oesophagitis in females. CONCLUSIONS The detrimental effect on erosive oesophagitis is greater by metabolic syndrome than by NAFLD in males but greater by NAFLD than by metabolic syndrome in females.
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Affiliation(s)
- Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, Dou-Liou Branch, Yunlin, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Mohammadi M, Ramezani Jolfaie N, Alipour R, Zarrati M. Is Metabolic Syndrome Considered to Be a Risk Factor for Gastroesophageal Reflux Disease (Non-Erosive or Erosive Esophagitis)?: A Systematic Review of the Evidence. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30363. [PMID: 28191340 PMCID: PMC5292393 DOI: 10.5812/ircmj.30363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 06/21/2015] [Accepted: 07/21/2015] [Indexed: 12/12/2022]
Abstract
CONTEXT The incidences of both gastroesophageal reflux disease (GERD) and metabolic syndrome (MetS) have increased in recent years, and it has been suggested that there is a probable association between the two. The aim of this review is to clarify whether or not MetS is a risk factor for the incidence of GERD. EVIDENCE AQUISITION We searched the PubMed, ProQuest, Ovid, Science Direct, and Google Scholar databases up to February 2015 regarding the relationship between GERD and MetS as found in observational studies. Any studies that evaluated the association between the components of MetS and GERD, as well as any studies examining the association of MetS with Barrett's esophagus or esophageal carcinoma, were excluded. RESULTS Thirteen studies met the eligibility criteria. The results of nine studies suggested that there was a higher prevalence of MetS among patients with GERD (P < 0.05) and, thus, it could be considered as an independent risk factor for the incidence of GERD. However, in the one study was not observed significant association between GERD and MetS (P = 0.71). Two studies in which the prevalence of GERD was compared between individuals with and without MetS showed a higher prevalence of GERD in patients with MetS (P < 0.05). However, this finding was not observed in a similar study conducted among female participants, which reported that the different types of MetS were not important factors with regard to the prevalence of erosive esophagitis (P = Not significant). CONCLUSIONS It can be concluded that MetS may increase the risk of GERD. Consequently, there might be potential benefits to treating the metabolic abnormalities in these patients.
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Affiliation(s)
- Mohammad Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
| | - Nahid Ramezani Jolfaie
- Department of Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Rooya Alipour
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mitra Zarrati
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
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Influence of metabolic syndrome on upper gastrointestinal disease. Clin J Gastroenterol 2016; 9:191-202. [DOI: 10.1007/s12328-016-0668-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/19/2016] [Indexed: 12/22/2022]
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Sogabe M, Okahisa T, Yamanoi A, Takayama T. Subtypes of metabolic syndrome and of other risk factors in Japanese women with erosive esophagitis. Medicine (Baltimore) 2014; 93:e276. [PMID: 25526458 PMCID: PMC4603098 DOI: 10.1097/md.0000000000000276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity and metabolic syndrome (MS) are strongly associated with erosive esophagitis (EE). The prevalence of MS and EE, and the distribution of adipose tissue have been known to differ markedly between men and women. Although the prevalence of EE in men with MS is known to be higher in visceral fat type MS (V-type MS) than in subcutaneous fat type MS (S-type MS), the association between EE and the types of MS in women with MS is unclear. This study was a cross-sectional study elucidating the association between EE and the types of MS in women with MS. Subjects were 454 women with MS who underwent a regular health check-up. A distinction was made between V-type MS and S-type MS and the prevalence of EE and the association between EE and other data were elucidated. Although there were some significant different factors in characteristics between V-type MS and S-type MS, there was no significant difference in the prevalence of EE between V-type MS and S-type MS. The presence of Helicobacter pylori (H. pylori) was significantly lower than in subjects with EE (13.7%) than in subjects without EE (41.9%). The frequency of hiatal hernia was significantly higher in subjects with EE (60.8%) than in subjects without EE (24.6%). Logistic regression analysis showed hiatal hernia (odds ratio: 4.673; 95% confidence interval: 2.448-8.920; P<0.001), hemoglobin A1c (HbA1c) (2.325; 1.110-4.870; P<0.05), and the presence of H. pylori (0.239; 0.101-0.567; P<0.005) were significant predictors of the prevalence of EE. V-type MS may not be such an important factor for the prevalence of EE in women with MS as in men with MS. The absence of H. pylori, hiatal hernia, and HbA1c may be more important for the prevalence of EE than the types of MS in women with MS.
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Affiliation(s)
- Masahiro Sogabe
- From the Department of General Medicine and Community Health Science, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima (MS, TO); Department of Gastroenterology, Kagawa Prefectural Cancer Detection Center, Takamatsu (MS, AY); and Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan (TT)
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Zenda T, Hamazaki K, Oka R, Hagishita T, Miyamoto S, Shimizu J, Inadera H. Endoscopic assessment of reflux esophagitis concurrent with hiatal hernia in male Japanese patients with obstructive sleep apnea. Scand J Gastroenterol 2014; 49:1035-43. [PMID: 25048181 DOI: 10.3109/00365521.2014.926984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. In addition, GERD has not been adequately assessed by endoscopy in patients with OSA. The purpose of this study was to use endoscopy to investigate potential interactions among reflux esophagitis, hiatal hernia (HH) and OSA. MATERIAL AND METHODS A total of 243 consecutive male Japanese participants who underwent both overnight ambulatory polygraphic monitoring and esophagogastroduodenoscopy were retrospectively evaluated in a cross-sectional study. The prevalence and severity of HH and reflux esophagitis were assessed according to the Los Angeles classification and the Makuuchi classification, respectively. Associations among reflux esophagitis, HH and OSA were examined by univariate and multivariate analyses. RESULTS OSA was diagnosed in 98 individuals (40.3%). Endoscopy-confirmed esophagitis (p = 0.027) and HH (p < 0.001) were significantly more prevalent among patients with OSA. Multivariate regression model analysis adjusted for age, body mass index, visceral obesity represented by waist circumference, presence of OSA, concurrence of OSA and HH, smoking, and alcohol consumption yielded OSA as the only variable significantly associated with HH (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.35-4.99; p = 0.004), while concurrence of OSA and HH was related to reflux esophagitis (OR, 3.59; CI, 1.87-6.92; p < 0.001). CONCLUSIONS OSA was associated with HH and concurrent OSA and HH with reflux esophagitis in male Japanese patients with OSA. Our results support the hypothesis that complicating HH may link reflux esophagitis to OSA.
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Affiliation(s)
- Takahiro Zenda
- Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers , Toyama , Japan
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Singh S, Sharma AN, Murad MH, Buttar NS, El-Serag HB, Katzka DA, Iyer PG. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11:1399-1412.e7. [PMID: 23707461 PMCID: PMC3873801 DOI: 10.1016/j.cgh.2013.05.009] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Central adiposity has been implicated as a risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), possibly promoting the progression from inflammation to metaplasia and neoplasia. We performed a systematic review and meta-analysis of studies to evaluate the association between central adiposity and erosive esophagitis (EE), BE, and EAC, specifically exploring body mass index (BMI)-independent and gastroesophageal reflux (GERD)-independent effects of central adiposity on the risk of these outcomes. METHODS We performed a systematic search of multiple databases through March 2013. Studies were included if they reported effect of central adiposity (visceral adipose tissue area, waist-hip ratio, and/or waist circumference) on the risk of EE, BE, and EAC. Summary adjusted odds ratio (aOR) estimates with 95% confidence intervals (CIs), comparing highest category of adiposity with the lowest category of adiposity, were calculated by using random-effects model. RESULTS Forty relevant articles were identified. Compared with patients with normal body habitus, patients with central adiposity had a higher risk of EE (19 studies; aOR, 1.87; 95% CI, 1.51-2.31) and BE (17 studies; aOR, 1.98; 95% CI, 1.52-2.57). The association between central adiposity and BE persisted after adjusting for BMI (5 studies; aOR, 1.88; 95% CI, 1.20-2.95). Reflux-independent association of central adiposity and BE was observed in studies that used GERD patients as controls or adjusted for GERD symptoms (11 studies; aOR, 2.04; 95% CI, 1.44-2.90). In 6 studies, central adiposity was associated with higher risk of EAC (aOR, 2.51; 95% CI, 1.54-4.06), compared with normal body habitus. CONCLUSIONS On the basis of a meta-analysis, central adiposity, independent of BMI, is associated with esophageal inflammation (EE), metaplasia (BE), and neoplasia (EAC). Its effects are mediated by reflux-dependent and reflux-independent mechanisms.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anamay N. Sharma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Navtej S. Buttar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hashem B. El-Serag
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - David A. Katzka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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