Abdominal Obesity Is an Independent Risk Factor for Endoscopic Reflux Esophagitis in Korean People

Abstract

Purpose: The relationship between reflux esophagitis and obesity is controversial in Korea, because morbid obesity (BMI > 30 kg/m2) is less common than Western countries. The aim of this study is to evaluate the relationship between obesity and endoscopic reflux esophagitis in Korean people. Methods: 2457 subjects who visited our health center for a general check-up including EGD during the period from September 2004 to April 2005 were enrolled. All of them were given a questionnaire about physical activity, smoking, consumption of alcohol, consumption of beverage, weekly symptom of heartburn or acid regurgitation, use of drugs, and other medical or surgical history. The subjects were classified into three groups by BMI: nonobese (<25 kg/m2), obese (25–30 kg/m2) and severe obese (>30 kg/m2). And abdominal obesity was defined by waist circumference (≥80 cm in women and ≥90 cm in men). Reflux esophagitis was diagnosed by EGD according to the LA classification (≥LA-A). Univariate analyses of various risk factors for reflux esophagitis was performed by using χ2 test, and then multiple logistic regression analyses was used to examine relationship between reflux esophagitis and obesity. Results: After exclusion of subjects who had gastric surgery, analysis was done on 2310 subjects (mean age was 44 ± 9 years and 31.3% was women). 28.8% was obese, 2.4% was severe obese, and 23.5% had abdominal obesity. The prevalence of endoscopic reflux esophagitis was 6.7% and significantly higher in men than in women (8.7%vs. 2.1%, p < 0.001). There was a dose-response relationship between prevalence of reflux esophagitis and BMI (5.7%, 8.2%, and 15.5% in <25, 25−30, and >30, respectively, p = 0.002). Waist circumference (11.2%vs. 5.2%, p < 0.001), hiatal hernia (42.6%vs. 5.8%, p < 0.001), current smoking (9.5%vs. 5.3%, p < 0.001), physical activity (7.6%vs. 4.2%, p = 0.002), use of hypertensive medications (12.7%vs. 6.1%, p = 0.005), and use of aspirin or NSAIDs (15.2%vs. 6.3%, p = 0.001) were significantly related with reflux esophagitis. After adjustment for sex, hiatal hernia, current smoking, physical activity, use of hypertensive medications, and use of aspirin or NSAIDs, only waist circumference remained as an independent risk factor for reflux esophagitis (adjusted OR 1.9, 95% CI 1.3–2.9, p = 0.002). Conclusions: Abdominal obesity is an independent risk factor for reflux esophagitis in Korean people.