Risk Factors For Erosive Esophagitis Research Articles

Risk factors and 26-years worldwide prevalence of endoscopic erosive esophagitis from 1997 to 2022: a meta-analysis

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.

The association between metabolic syndrome and erosive esophagitis: A systematic review and meta-analysis.

Although several studies have shown that each of the metabolic syndrome (MetS) components can be a risk factor for erosive esophagitis (EE), the association between MetS and EE is still a challenging subject, as studies about this association have shown inconsistent results. Therefore, this study was conducted to evaluate the association between MetS and EE. In this study, we followed the MOOSE protocol and the PRISMA guidelines for reporting the results. Web of Science (ISI), Cochrane Library (Cochrane Database of Systematic Reviews - CDSR), EMBASE, Scopus, Science Direct, PubMed/Medline, EBSCO, CINAHL, and Google Scholar search engine were searched for articles published until January 2021. Heterogeneity between studies was estimated by I2 index and Q test. All analyses were performed using Comprehensive Meta-Analysis Software. Finally, 12 studies entered the meta-analysis process after qualitative assessment. MetS was significantly associated with increased risk of EE (OR=1.488 [95 % CI: 1.352-1.638], P<0.001; Heterogeneity: I2= 55.57, P<0.001) in 12 studies with a sample size of 45285 (12825 cases and 29377 controls). In subgroup analysis based on types of studies (P=0.832), MetS diagnostic criteria (P=0.083) and quality of studies (P=0.612), no significant association was found. Sensitivity analysis showed that the overall estimation of effect size is still robust after omission of individual studies from the meta-analysis. Publication bias based on the Begg's test (P=0.945) and Egger's test (P=0.753) were not significant. MetS increases the risk of EE compared to control groups. Future studies should examine if MetS treatment reduces the risk of EE.

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40\u201369-years subjects

BackgroundVisceral fat obesity can be defined quantitatively by abdominal computed tomography, however, the usefulness of measuring visceral fat area to assess the etiology of gastrointestinal reflux disease has not been fully elucidated.MethodsA total of 433 healthy subjects aged 40–69 years (234 men, 199 women) were included in the study. The relationship between obesity-related factors (total fat area, visceral fat area, subcutaneous fat area, waist circumference, and body mass index) and the incidence of reflux erosive esophagitis was investigated. Lifestyle factors and stomach conditions relevant to the onset of erosive esophagitis were also analyzed.ResultsThe prevalence of reflux erosive esophagitis was 27.2% (118/433; 106 men, 12 women). Visceral fat area was higher in subjects with erosive esophagitis than in those without (116.6 cm2 vs. 64.9 cm2, respectively). The incidence of erosive esophagitis was higher in subjects with visceral fat obesity (visceral fat area ≥ 100 cm2) than in those without (61.2% vs. 12.8%, respectively). Visceral fat obesity had the highest odds ratio (OR) among obesity-related factors. Multivariate analysis showed that visceral fat area was associated with the incidence of erosive esophagitis (OR = 2.18), indicating that it is an independent risk factor for erosive esophagitis. In addition, daily alcohol intake (OR = 1.54), gastric atrophy open type (OR = 0.29), and never-smoking history (OR = 0.49) were also independently associated with the development of erosive esophagitis.ConclusionsVisceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in subjects aged 40–69 years.

Risk factors of erosive esophagitis and barrett's esophagus in patients with reflux symptoms.

Background: Gastroesophageal reflux disease (GERD) is a prevalent condition. Erosive esophagitis (EE) and Barrett’s esophagus (BE) are the two important complications of GERD. We aimed to study the prevalence of EE and BE in a group of Patients with reflux symptoms who were referred for endoscopy. The relationship between reflux symptoms and endoscopic findings was also examined. Methods: We enrolled 139 consecutive patients with characteristic symptoms of GERD. Demographic and clinical characteristics of the patients including duration and severity of reflux symptoms, were recorded. Endoscopic findings of EE were identified and classified according to the Los Angeles classification, while BE was confirmed by histopathology examination. The Fisher’s exact test and the two-sample 𝑡-test were used to test the association of esophageal lesions (BE and/or EE) with the patients' clinical and endoscopic data. Results: Forty seven and 13 patients were found to have EE and BE, respectively. Multivariate analysis showed that older age (p=0.001) and hiatal hernia (p=0.004) was significantly related risk factors for erosive esophagitis and BE. While an increase in BMI (p=0.004) was related to EE, patients with BE were more likely to have severe reflux symptoms than others (p=0.002). Conclusion: In patients with GERD, the presence of hiatal hernia may be strong risk factor for erosive esophagitis and BE, as does older age. For Barrett’s esophagus, severe reflux symptoms are more likely.

The Association between Metabolic Syndrome and Increased Risk of Erosive Esophagitis: A Systematic Review and Meta-Analysis

Background: Although several studies have shown that each of the metabolic syndrome (MetS) components can be a risk factor for erosive esophagitis (EE), the association between MetS and EE is still a challenging subject, as studies about this association have shown inconsistent results. Therefore, this study was conducted to evaluate the association between MetS and EE. Method: In this study, we followed the MOOSE protocol and the PRISMA guidelines for reporting the results. Web of Science (ISI), Cochrane Library (Cochrane Database of Systematic Reviews - CDSR), EMBASE, Scopus, Science Direct, PubMed/Medline, EBSCO, CINAHL, and Google Scholar search engine searched for articles published until July 2019. Heterogeneity between studies was estimated by I2 index and Q test. All analyses were performed using Comprehensive Meta-Analysis Software. Finding: MetS was significantly associated with increased risk of EE (OR=1.488 [95%CI: 1.352-1.638], P< 0.001; Heterogeneity: I2= 55.57, P< 0.001) in 12 studies with a sample size of 45285 (12825 cases and 29377 controls). In subgroup analysis based on types of studies (P=0.832), MetS diagnostic criteria (P=0.083) and studies quality (P=0.612), we not found significant difference. Meta-regression for the association between MetS and EE based on year of publication was not significant (meta-regression coefficient: -0.009 [95% CI: -0.037 to 0.019], P = 0.529). Sensitivity analysis was used to omit one study to show the overall estimation power and showed that the overall estimation is still robust. Publication bias based on the Begg's test (P = 0.945) and Egger's test (P = 0.753) were not significant. Interpretation: MetS increases the risk of EE compared to control groups. Future studies should examine if MetS treatment reduces the risk of EE. Funding Statement: Ilam University of Medical Sciences. Declaration of Interests: The authors declare no competing interests. Ethical Approval Statement: Not required.

Association Between Erosive Esophagitis and the Anthropometric Index in the General Korean Population

Background:An association between obesity and gastroesophageal reflux disease has been reported. However, previous studies have focused on obesity or central obesity.Aims:To investigate the association of the anthropometric index and endoscopic erosive esophagitis in health checkups of Koreans.Study Design:Case-control study.Methods:A total of 1.207 consecutive subjects (aged 40-80 years) during health checkups underwent upper endoscopy and bioelectrical impedance analysis. We collected anthropometric data by bioelectrical impedance analysis, which consisted of body mass index, percent body fat, muscle mass, and fat mass.Results:Of 1.207 subjects who underwent upper gastrointestinal endoscopy (mean age, 50.55±9 years), 239 (19.8%) had endoscopic erosive esophagitis. In a univariate analysis, the endoscopic erosive esophagitis group was more likely to be a male and had a higher body mass index, muscle mass and fat mass. In logistic regression analysis, only muscle mass remained an independent risk factor for EE after adjustment for both age and gender. Higher muscle mass was associated with increased EE risk (rate ratio: 1.354, 95% confidence interval: 1.206-1.405, p= 0.027).Conclusion:High muscle mass, but body mass index, is an independent risk factor for erosive esophagitis in a population over 40 years of age.

Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery

BackgroundGastroesophageal reflux disease (GERD) is common in obese individuals. Prospective studies investigating validated GERD questionnaires and clinical parameters at identifying erosive esophagitis (EE) in this population are limited. ObjectiveTo prospectively evaluate the prevalence of GERD in obese patients considered for bariatric surgery and identify risk and predictive factors for EE. MethodsEligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy. Results242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean BMI 40.4 ± 5.3 kg/m2). The overall prevalence of gastroesophageal reflux (GERDQ ≥ 8, EE and/or PPI use) was 62.4%. EE was identified in 82 patients (33.9%) including 13/62 (21.0%) receiving PPIs at baseline. Multivariate logistic regression identified GERDQ ≥ 8 (OR = 6.3, 95%CI 3.0–13.1), hiatal hernia (OR = 4.2, 95%CI 1.6–10.7), abnormal Hill grade (OR = 2.7, 95%CI 1.4–5.4), and tobacco use (OR = 2.5, 95%CI 1.2–4.9) as independent risk factors for EE. A pre-endoscopic composite assessment including GERDQ ≥ 8 and presence of severe nocturnal reflux symptoms had 90% specificity and 20.7% sensitivity in identifying EE (NPV 68.9% and PPV 51.5%). ConclusionGERD is highly prevalent in obese patients. Anthropometric data and GERD questionnaires have limited accuracy at predicting erosive disease. Pre-operative endoscopic assessment in this population appears warranted.

Asthma under control is inversely related with erosive esophagitis among healthy adults.

BackgroundSome recent studies suggested that reflux esophagitis is positively correlated with asthma. However, there are debates on this issue. The aim of this study is to clarify the true association between reflux esophagitis and asthma in a large population.MethodsMedical records of subjects who received health surveillance checkup between January 2005 and December 2011 were reviewed. Their endoscopic findings, medical history, body mass index, and smoking history were analyzed. Erosive esophagitis was defined as endoscopically detected mucosal break at the Z-line, irrespective of reflux symptom. Information about asthma history was obtained from their questionnaires and medical records.ResultsOut of the total 15,999 patients, 986 had erosive esophagitis and 376 had asthma. In this population, erosive esophagitis was inversely related with asthma in univariable analysis (OR, 0.586; 95% CI, 0.342–1.003, p = 0.049). In multivariable analysis, asthma was demonstrated as an independent negative risk factor for erosive esophagitis (OR, 0.472; 95% CI, 0.257–0.869, p = 0.016), under adjustment with age (OR, 1.000; 95% CI, 0.994–1.006, p = 0.977), male sex (OR, 2.092; 95% CI, 1.683–2.601, p < 0.001), body mass index (OR, 1.115; 95% CI, 1.090–1.141, p < 0.001), smoking (OR, 1.584; 95% CI, 1.318–1.902, p < 0.001), and urban residence (OR, 1.363; 95% CI, 1.149–1.616, p < 0.001). Likewise, erosive esophagitis was shown to be an independent negative risk factor for asthma (OR, 0.558; 95% CI, 0.324–0.960, p = 0.035) under adjustment with age (OR, 1.025; 95% CI, 1.015–1.034, p <0.001), male sex (OR, 0.861; 95% CI, 0.691–1.074, p = 0.185), and body mass index (OR, 1.067; 95% CI, 1.030–1.106, p < 0.001) in multivariable analysis.ConclusionsContrary to previous studies, this large scale data showed inverse association between erosive esophagitis and asthma. Further studies investigating the clear mechanism of this phenomenon are warranted.

Obesity increases the risk of erosive esophagitis but metabolic unhealthiness alone does not: a large-scale cross-sectional study

BackgroundObesity is a known risk factor for erosive esophagitis (EE) and metabolic unhealthiness has been implicated in EE pathogenesis. However, obesity and metabolic unhealthiness are not synonymous and the associations between obesity, metabolic health, and EE are unclear. Therefore, our aim was to investigate the relationship between EE, obesity, and metabolic health.MethodsWe performed a retrospective cross-sectional study of subjects undergoing health screening at a university hospital. Subjects were classified into 4 groups based on metabolic and obesity criteria: metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy nonobese (MUNO), and metabolically unhealthy obese (MUO). Multivariable analysis was used to identify EE risk factors with MHNO subjects as reference. To determine if there were synergistic interactions between metabolic health and obesity status, the Rothman’s synergy index and attributable proportion of risk were also calculated.ResultsWe included 10,338 subjects (5448 MHNO, 1605 MHO, 1600 MUNO, 1685 MUO). The prevalence of EE was 6.5% in MHNO, 12.6% in MHO, 9.3% in MUNO, and 14.3% in MUO. EE risk was increased significantly by obesity (MHO: OR, 1.589, 95% CI, 1.314–1.921, P < 0.001; MUO: OR, 1.734, 95% CI, 1.441–2.085, P < 0.001), but not in MUNO subjects (OR, 1.224, 95% CI, 0.991–1.511, P = 0.060). Male sex, blood leukocyte count, alcohol, and smoking significantly increased EE risk, but H. pylori infection was protective. Replacement of obesity with abdominal obesity gave similar results. The Rothman’s synergy index was 0.920 (95% CI, 0.143–5.899) and the attributable proportion of risk was − 0.051 (95% CI, − 1.206–1.105), indicating no interaction between metabolic and obesity status on EE risk.ConclusionsWe demonstrated that obesity increased the risk of EE, regardless of metabolic health status. However, EE risk was not significantly increased in MUNO subjects, suggesting that metabolic unhealthiness may not be involved in EE pathogenesis. As observational cross-sectional studies cannot prove causality, prospective longitudinal studies involving obesity and metabolic treatment should be performed to further investigate the association between obesity, metabolic health, and EE risk.

Su1104 - Prevalence and Risk Factors for Erosive Esophagitis in Obese Patients Considered for Bariatric Surgery

Su1104 - Prevalence and Risk Factors for Erosive Esophagitis in Obese Patients Considered for Bariatric Surgery

CLINICAL, ENDOSCOPIC AND ESOPHAGEAL PH-IMPEDENCE STUDY IN PATIENTS WITH HEARTBURN REFERRED TO KURDISTAN CENTER FOR GASTROENTEROLOGY AND HEPATOLOGY

Background&#x0D; Heartburn is characterized by a discomfort or burning sensation behind the sternum that arises from the epigastrium and may radiate toward the neck. A subset of patients with heartburn are Non-erosive reflux disease (NERD) is characterized by reflux symptoms in the absence of esophageal mucosal breaks, with objective evidence of pathological levels of gastroesophageal reflux on pH or pH-impedance monitoring.&#x0D; Objectives&#x0D; To evaluate patients with heartburn clinically, endoscopically and by combined pH-impedance study.&#x0D; Methodology&#x0D; This is a cross-sectional descriptive study, a total of 60 cases of heartburn, referred to Kurdistan center for Gastroenterology and Hepatology in Sulaimani from February 2015 to December 2015 were enrolled. Cases interviewed and a questionnaire filled; body mass index measured. OGD and pH-impedance study were done for all participants.&#x0D; Results &#x0D; Out of 60 cases of heartburn, erosive esophagitis (EE) found in 21.7% of cases and 78.7% had normal OGD. Regurgitation found in almost all cases of EE (100%) which was statistically significant (p=0.02). Patients with hiatus hernia HH are at greater risk for EE than non-erosive cases (p=0.01). By OGD and pH-study more than half of our cases (51.6%) were proved to have gastroesophageal reflux disease (GERD). There was significant different (p &lt;0.001) between those with erosive and non-erosive esophagitis in relation to number of reflux episodes and intensity of acid exposure.&#x0D; Conclusion&#x0D; Only 21.3% of heartburn cases had EE. Having HH is a risk factor for EE. Almost half of cases with EE had abnormal pH-study; this means ODG has low sensitivity in the diagnosis of GERD with greater specificity. Adding combined pH-impedance test to OGD in the evaluation of heartburn increase the diagnostic utility of GERD.

Central Obesity as a Risk Factor for Non-Erosive Reflux Disease.

PurposeAlthough central obesity is a risk factor for erosive esophagitis, information regarding the association between central obesity and non-erosive reflux disease (NERD) is still scarce. The purpose of this study was to investigate the risk factors for NERD by comparing NERD patients and healthy controls.Materials and MethodsComprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December 2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnaire was used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects according to propensity scores.ResultsThere were 119 NERD patients and 259 controls. In multivariate analysis, central obesity, female gender, and younger age were significantly associated with NERD [odds ratio (OR)=2.55, 1.93, and 1.80; p=0.001, 0.005, and 0.011, respectively]. After adjusting for 12 clinical variables using propensity score matching, 114 NERD patients were matched to 114 controls. All variables were well balanced between the two groups (average D before matching: 0.248, after matching: 0.066). Patients with NERD were more likely to have central obesity than healthy controls (28.1% vs. 7.9%). After adjusting for propensity scores and all covariates in multivariable logistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001).ConclusionCentral obesity appears to be an independent risk factor for NERD. This result supports the presence of an association between GERD and central obesity, even in the absence of esophageal erosion (NERD).

Impact of night-shift work on the prevalence of erosive esophagitis in shipyard male workers.

PurposeWhether night-shift work is a risk factor for gastroesophageal reflux disease is controversial. The aim of this study was to investigate the association between night-shift work and other factors, and erosive esophagitis.MethodsA cross-sectional study with 6040 male shipyard workers was performed. Esophagogastroduodenoscopic examination and a survey about night-shift work status, lifestyle, medical history, educational status, and marital status were conducted in all workers. The odds ratios of erosive esophagitis according to night-shift work status were calculated by using the logistic regression model.ResultsThe prevalence of erosive esophagitis increased in the night-shift workers [odds ratio, 95 % confidence interval: 1.41 (1.03–1.94)]. According to multiple logistic regression models, night-shift work, obesity, smoking, and alcohol consumption of ≥140 g/week were significant risk factors for erosive esophagitis. By contrast, Helicobacter pylori infection was negatively associated with erosive esophagitis.ConclusionNight-shift work is suggested to be a risk factor for erosive esophagitis. Avoidance of night-shift work and lifestyle modification should be considered for prevention and management of gastroesophageal reflux disease.

WITHDRAWN: Sarcopenia as a leading risk factor for erosive esophagitis

WITHDRAWN: Sarcopenia as a leading risk factor for erosive esophagitis

Metformin With Either Histamine H2-Receptor Antagonists or Proton Pump Inhibitors: A Polypharmacy Recipe for Neuropathy via Vitamin B12 Depletion.

According to the most recent data from the Centers for Disease Control and Prevention, 25.8 million people in the United States (8.3% of the population) have diabetes (1). Type 2 diabetes accounts for 90–95% of diabetes diagnoses, and >85% of people with type 2 diabetes are overweight or obese (1). Increased BMI, which is common in the type 2 diabetes population, has a well-established association with symptoms of gastroesophageal reflux disease (GERD) (2,3). Central adiposity is an important risk factor in the development of reflux and, subsequently, erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, and gastric cardia adenocarcinoma (2,3). Increased BMI is not the only risk factor for the development of GERD, particularly among people with diabetes. Among those with type 2 diabetes, peripheral neuropathy is an independent risk factor for erosive esophagitis (4). In this population, there is a greater incidence of erosive esophagitis among individuals with neuropathy than among those without neuropathy, although those with and without neuropathy experience similar GERD symptoms (4). Approximately 60–70% of people with diabetes have mild to severe forms of nervous system damage, which may partly explain why low-grade esophageal dysplasia is twice as likely in individuals with than in those without diabetes (1,5). Additionally, both asymptomatic and symptomatic reflux is more prevalent in individuals with diabetes than in those without diabetes (6,7). Likewise, type 2 diabetes has been demonstrated to be a risk factor for symptomatic GERD (8). Among individuals with diabetes, 40.7% experience symptomatic GERD, and 70% of those use oral antidiabetic medications. Thus, it is likely that millions of individuals are managing blood glucose and GERD concomitantly with oral medications (1,7) Therefore, it is important to assess the drug interactions and clinical sequelae that may occur with this particular …

Tu1096 Postprandial Pepsin in Saliva in Healthy Subjects and Patients With GERD. Relationship With Postprandial Reflux

BACKGROUND: The Controlled Attenuation Parameter (CAP) is promising tool for the noninvasive detection of hepatic steatosis using a process based on transient elastography. The relationship between CAP and erosive esophagitis (EE) was investigated. METHODS: A total of 1,139 subjects from a health promotion center at Yonsei University Health System, Seoul, Korea were enrolled. Esophagogastroduodenoscopy (EGD) and liver transient elastography were done in all participants. The association between EE and hepatic steatosis was estimated with odds ratios (ORs) and 95% confidence intervals (CIs). Blood pressure, body mass index (BMI), skeletal muscle mass, body fat mass, percent body fat, waist-hip ratio (WHR), serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), triglyceride (TG), fasting glucose, HbA1c were compared between individuals with and without EE. Risk factors for EE were evaluated by multivariate logistic regression. Severity of hepatic steatosis by CAP score was defined as S0 (less than 270 dB/m), S1 (270-299 dB/m), S2 (300-319 dB/m), and S3 (≥300 dB/m). RESULTS:: The prevalence of erosive esophagitis was 6.6% (75/1,139). Severity of hepatic steatosis and was positively associated with prevalence (3.8% in S0, 12.5% in S1, 18.4% in S3, and 27.8% in S4, p<0.001), as well as severity of erosive esophagitis (p<0.001). Male gender, high CAP score, high waist-hip ratio, high diastolic blood pressure, high BMI, high TG level and hiatus hernia was associated with EE (p<0.001 for each factor). In a multivariate analysis, male gender (OR, 2.45, 95% CI, 1.37-4.38, p= 0.003), central obesity (OR, 1.41, 95% CI, 1.02-1.91, p= 0.024), hiatus hernia (OR, 3.79, 95% CI, 1.05-13.59, p=0.031), and hepatic steatosis were significantly associated with erosive esophagitis. The OR of EE for hepatic steatosis was 3.08 (95% CI, 1.68-5.67) for S1, 5.77 (95% CI, 2.55-13.41) for S2, and 8.79 (95%CI, 4.32-17.85) for S3, compared with participants with S0 (p<0.001) CONCLUSION:: Hepatic steatosis is associated with increased risk and severity of erosive esophagitis. In addition, male gender, central obesity and hiatus hernia were also positively associated with erosive esophagitis.

Tu1097 Limitations of the Symptom Reflux Association During Ambulatory Impedance-pH Monitoring: Back to Basic Objective Parameters?

BACKGROUND: The Controlled Attenuation Parameter (CAP) is promising tool for the noninvasive detection of hepatic steatosis using a process based on transient elastography. The relationship between CAP and erosive esophagitis (EE) was investigated. METHODS: A total of 1,139 subjects from a health promotion center at Yonsei University Health System, Seoul, Korea were enrolled. Esophagogastroduodenoscopy (EGD) and liver transient elastography were done in all participants. The association between EE and hepatic steatosis was estimated with odds ratios (ORs) and 95% confidence intervals (CIs). Blood pressure, body mass index (BMI), skeletal muscle mass, body fat mass, percent body fat, waist-hip ratio (WHR), serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), triglyceride (TG), fasting glucose, HbA1c were compared between individuals with and without EE. Risk factors for EE were evaluated by multivariate logistic regression. Severity of hepatic steatosis by CAP score was defined as S0 (less than 270 dB/m), S1 (270-299 dB/m), S2 (300-319 dB/m), and S3 (≥300 dB/m). RESULTS:: The prevalence of erosive esophagitis was 6.6% (75/1,139). Severity of hepatic steatosis and was positively associated with prevalence (3.8% in S0, 12.5% in S1, 18.4% in S3, and 27.8% in S4, p<0.001), as well as severity of erosive esophagitis (p<0.001). Male gender, high CAP score, high waist-hip ratio, high diastolic blood pressure, high BMI, high TG level and hiatus hernia was associated with EE (p<0.001 for each factor). In a multivariate analysis, male gender (OR, 2.45, 95% CI, 1.37-4.38, p= 0.003), central obesity (OR, 1.41, 95% CI, 1.02-1.91, p= 0.024), hiatus hernia (OR, 3.79, 95% CI, 1.05-13.59, p=0.031), and hepatic steatosis were significantly associated with erosive esophagitis. The OR of EE for hepatic steatosis was 3.08 (95% CI, 1.68-5.67) for S1, 5.77 (95% CI, 2.55-13.41) for S2, and 8.79 (95%CI, 4.32-17.85) for S3, compared with participants with S0 (p<0.001) CONCLUSION:: Hepatic steatosis is associated with increased risk and severity of erosive esophagitis. In addition, male gender, central obesity and hiatus hernia were also positively associated with erosive esophagitis.

Tu1095 Hepatic Steatosis Is Associated With Increased Risk and Severity of Erosive Esophagitis

BACKGROUND: The Controlled Attenuation Parameter (CAP) is promising tool for the noninvasive detection of hepatic steatosis using a process based on transient elastography. The relationship between CAP and erosive esophagitis (EE) was investigated. METHODS: A total of 1,139 subjects from a health promotion center at Yonsei University Health System, Seoul, Korea were enrolled. Esophagogastroduodenoscopy (EGD) and liver transient elastography were done in all participants. The association between EE and hepatic steatosis was estimated with odds ratios (ORs) and 95% confidence intervals (CIs). Blood pressure, body mass index (BMI), skeletal muscle mass, body fat mass, percent body fat, waist-hip ratio (WHR), serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), triglyceride (TG), fasting glucose, HbA1c were compared between individuals with and without EE. Risk factors for EE were evaluated by multivariate logistic regression. Severity of hepatic steatosis by CAP score was defined as S0 (less than 270 dB/m), S1 (270-299 dB/m), S2 (300-319 dB/m), and S3 (≥300 dB/m). RESULTS:: The prevalence of erosive esophagitis was 6.6% (75/1,139). Severity of hepatic steatosis and was positively associated with prevalence (3.8% in S0, 12.5% in S1, 18.4% in S3, and 27.8% in S4, p<0.001), as well as severity of erosive esophagitis (p<0.001). Male gender, high CAP score, high waist-hip ratio, high diastolic blood pressure, high BMI, high TG level and hiatus hernia was associated with EE (p<0.001 for each factor). In a multivariate analysis, male gender (OR, 2.45, 95% CI, 1.37-4.38, p= 0.003), central obesity (OR, 1.41, 95% CI, 1.02-1.91, p= 0.024), hiatus hernia (OR, 3.79, 95% CI, 1.05-13.59, p=0.031), and hepatic steatosis were significantly associated with erosive esophagitis. The OR of EE for hepatic steatosis was 3.08 (95% CI, 1.68-5.67) for S1, 5.77 (95% CI, 2.55-13.41) for S2, and 8.79 (95%CI, 4.32-17.85) for S3, compared with participants with S0 (p<0.001) CONCLUSION:: Hepatic steatosis is associated with increased risk and severity of erosive esophagitis. In addition, male gender, central obesity and hiatus hernia were also positively associated with erosive esophagitis.

Erosive esophagitis associated with metabolic syndrome, impaired liver function, and dyslipidemia

To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components, abnormal liver function, and lipoprotein profiles. We conducted a cross-sectional, case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan. Metabolic syndrome components, body mass index (BMI), liver function, dyslipidemia, and cardiovascular risk factors, as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C), and the ratio of low-density lipoprotein cholesterol to HDL-C were compared between individuals with and without erosive esophagitis. Risk factors for erosive esophagitis were evaluated by multivariate logistic regression. Erosive esophagitis was diagnosed in 507 of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects. In patients with erosive esophagitis, BMI, waist circumference, blood pressure, fasting plasma glucose, triglyceride levels, aspartate aminotransferase, alanine aminotransferase, the ratio of total cholesterol to HDL-C, and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis (all P < 0.05). In a multivariate analysis, central obesity (OR = 1.38; 95%CI: 1.0-1.86), hypertension (OR = 1.35; 95%CI: 1.04-1.76), hypertriglyceridemia (OR = 1.34; 95%CI: 1.02-1.76), cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C > 5 (OR = 1.45; 95%CI: 1.06-1.97), and aspartate aminotransferase (OR = 1.59; 95%CI: 1.08-2.34) were significantly associated with erosive esophagitis. Metabolic syndrome, impaired liver function, and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.

A Cross-Sectional Study on the Risk Factors for Erosive Esophagitis in Young Adults

To investigate the impact of metabolic and lifestyle factors on erosive esophagitis in young adults. A total of 5,069 people under the age of 40 years old were enrolled in a medical survey at our institute. People with a previous history of upper gastrointestinal tract surgery were excluded, as were individuals taking medication for reflux symptoms, peptic ulcers, or malignancies. Independent and significant predictors affecting the presence of erosive esophagitis were determined by multivariate analysis. A total of 4,990 participants (male/female; 3,871/1,119, age; 33.9±3.9 years) were eligible. A total of 728 participants (14.6%) had erosive esophagitis. Male gender and increasing age were independent predictors for increased prevalence of erosive esophagitis (odds ratio=2.242 and 1.045. 95% confidence interval=1.613-3.117 and 1.019-1.072; p<0.001 and 0.001, respectively). Moderate-to-heavy alcohol consumption, light-to-moderate-to-heavy smoking, hypertension, hyperglycemia, and hiatal hernia each significantly and independently increased the risk for erosive esophagitis (odds ratio=1.499, 1.398, 1.353, 1.570, 1.884, 1.297, 1.562, and 3.213. 95% confidence interval=1.181-1.903, 1.040-1.880, 1.094-1.675, 1.250-1.971, 1.307-2.716, 1.074-1.566, 1.063-2.295, and 2.712-3.807; p=0.001, 0.027, 0.005, <0.001, 0.001, <0.001, 0.007, 0.023, and <0.001 respectively). Helicobacter pylori infection decreased the risk for erosive esophagitis (odds ratio=0.575, 95% confidence interval =0.436-0.759 p<0.001). Neither body mass index nor waist girth conferred increased risk of erosive esophagitis after adjusting for potential confounding factors. Risk of erosive esophagitis in Japanese young adults was not increased by obesity, but it was increased by hiatal hernia and metabolic and lifestyle profiles including hypertension, hyperglycemia, alcohol consumption and smoking.