Risk Factors For Reflux Esophagitis Research Articles

Risk Factors for Helicobacter pylori Infection and Endoscopic Reflux Esophagitis in Healthy Young Japanese Volunteers.

Objective The aim of this study was to determine the prevalence and risk factors of reflux esophagitis and Helicobacter pylori (H.pylori) infection and their interrelationship in healthy young Japanese volunteers. Methods Between 2010 and 2016, 550 fifth-year medical students at Saga Medical School, aged 22 to 30 years, underwent upper gastrointestinal endoscopy and completed a questionnaire (frequency scale for symptoms of gastroesophageal reflux disease). H. pylori infection was determined by detecting urinary immunoglobulin G antibodies. Results H. pylori antibodies were detected in 45 of the 550 subjects (8.2%). Endoscopic reflux esophagitis was detected in 38 out of 550 (6.9%): grade A in 37 subjects (97.3%) and grade B in 1. Most subjects with reflux esophagitis were H. pylori-negative (35/37). Nodular gastritis was observed in 33.3% (15/45) of H. pylori-positive subjects. The risk factors for H. pylori infection were drinking well water in childhood, nodular gastritis, and duodenal ulcer scars. The risk factors for endoscopic reflux esophagitis were male gender and obesity (body mass index ≥25). Conclusion This study describes the risk factors for H. pylori infection and reflux esophagitis in healthy young Japanese subjects. The prevalence of reflux esophagitis was relatively high, and the infection rate of H. pylori was low compared with the aged Japanese population.

Risk Factors for Reflux Esophagitis in General Medical Checkup Examinees

Risk Factors for Reflux Esophagitis in General Medical Checkup Examinees

Retrocolic or Antecolic Roux-en-Y Reconstruction after Distal Gastrectomy: Which Is More Effective in the Prevention of Postoperative Gastroesophageal Reflux Disease?

Background: It is unclear which reconstructive route (retrocolic or antecolic) is more effective in preventing postoperative gastroesophageal reflux disease (GERD) in Roux-en-Y reconstruction following distal gastrectomy. Methods: Eighty-one eligible patients (retrocolic, n = 39; antecolic, n = 42) underwent endoscopies before surgery and 1 year after surgery to evaluate reflux esophagitis according to the Los Angeles classifications. The relative anatomical position of gastrojejunostomy to the cardia was measured by CT imaging. Results: The proportion of patients with reflux esophagitis was also significantly higher in the antecolic group than in the retrocolic group (38.1 vs. 10.3%, p = 0.005). Multivariate analysis revealed that antecolic reconstruction and body mass index (BMI) were independent risk factors for reflux esophagitis. The relative position of gastrojejunostomy to the cardia in the antecolic group was shifted to the left laterally (59.0 vs. 28.8 degree, p < 0.001) and ventrally (65.4 vs. 39.8 degree, p < 0.001) than in the retrocolic group. There was a positive correlation between BMI and left lateral and ventral shifts of gastrojejunostomy in the antecolic group. Conclusion: Retrocolic reconstruction may be superior to antecolic reconstruction in preventing postoperative GERD, especially in obese patients. The left lateral and ventral shifts of gastrojejunostomy after antecolic reconstruction may aggravate the occurrence of GERD.

New endoscopic classification of cascade stomach, a risk factor for reflux esophagitis

We recently demonstrated that cascade stomach detected by barium studies was correlated with upper gastrointestinal symptoms. We developed a new endoscopic classification of cascade stomach and examined its relationship with reflux esophagitis. Study 1: the classification (grades 0-3) was based on detecting a ridge that runs from the cardia toward the anterior wall crossing the greater curvature. Inter-observer variation was evaluated by kappa statistics when ten experienced endoscopists used this classification three times each. Study 2: in 710 consecutive subjects (500 men and 210 women) undergoing endoscopic screening, the grade of cascade stomach and incidence of reflux esophagitis were compared. In study 1, the kappa values at the third assessment were 0.85, 0.58, 0.50, and 0.78 for each grade, respectively, while overall agreement was 0.68. In study 2, the incidence of reflux esophagitis in men was 20% in grade 0, 17% in grade 1, 25% in grade 2, and 30% in grade 3, showing significant differences. Among women, the incidence of reflux esophagitis in each grade was 9, 3, 6, and 35%, respectively, also showing significant differences. Multivariate analysis showed that independent risk factors for reflux esophagitis were cascade stomach (odds ratio=2.20), body mass index, and hiatus hernia in men, as well as cascade stomach (odds ratio=9.01) and smoking tobacco in women. This endoscopic classification of cascade stomach showed acceptable inter-observer variation. Cascade stomach is a risk factor for reflux esophagitis.

Prevalence of severe esophagitis in Spain. Results of the PRESS study (Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional study).

*N.P. and M.P. contributed equally to this study.The current prevalence of esophagitis in southern Europe is unknown. In addition, the risk factors for reflux esophagitis are not fully understood. The objective of this article is to assess the prevalence and risk factors for esophagitis in Spain. A prospective, observational, cross-sectional, multicenter study (PRESS study) was conducted among 31 gastrointestinal endoscopy units throughout Spain. A total of 1361 patients undergoing upper gastrointestinal endoscopy were enrolled. Sociodemographic, clinical and treatment data were recorded. A total of 95% of patients were Caucasian and 52% were male (mean age: 53 ± 17 years). The most frequent symptoms prompting endoscopy were heartburn (40%), regurgitation (26%) and dysphagia (15%). Fifty-four percent of patients undergoing endoscopy were receiving proton pump inhibitor (PPI) treatment. Esophagitis (mainly mild-moderate) was present in 154 (12.4%) patients. The severe form was recorded in only 11 (0.8%) patients. Multivariate analysis results indicated that the likelihood of esophagitis was higher in men (OR = 1.91, 95% CI = 1.31-2.78), in patients with high GERD-Q scores (OR = 1.256, 95% CI = 1.176-1.343), weight increase (OR = 1.014, 95% CI = 1.003-1.025) and high alcohol consumption (OR = 2.49, 95% CI = 1.16-5.36). Severe esophagitis is a rare finding in the Spanish population. Male gender, high GERD-Q score, weight increase and high alcohol consumption are main risk factors for its appearance.

Risk factors for reflux esophagitis in elderly patients with type 2 diabetes mellitus

Risk factors for reflux esophagitis in elderly patients with type 2 diabetes mellitus

Endoscopic Cascade Stomach Is a Risk Factor for Reflux Esophagitis

Introduction: We recently demonstrated (Kusano M, et al. Neurogastroent Motil, 2012) that both Japanese men and women with cascade stomach (CS) on barium studies have a markedly elevated incidence of upper gastrointestinal symptoms, especially reflux symptoms. We hypothesized that CS might not only be associated with symptoms, but also with esophageal mucosal injury. Methods: Study 1: We developed a new endoscopic classification of CS based on the fundal incisura angularis (ridge), which is observed immediately after the endoscope passes through the cardia. The classification comprised four grades: grade 0, no ridge between fundus and corpus; grade 1, a ridge between fundus and corpus at endoscope insertion; grade 2, the ridge is also seen by retroflexed observation; and grade 3, the ridge is still observed after full gastric inflation. To assess inter-observer variation of this classification by calculating kappa statistics, 60 endoscopic photos were selected, and grading of CS was done three times at intervals > 1 week by 10 experienced endoscopists. Study 2: In 500 consecutive men and 189 women undergoing endoscopy for health screening, the incidence of reflux esophagitis (RE) and the grade of CS were compared. RE was defined as changes exceeding grade A of the LA classification, while hiatus hernia (HH) was protrusion > 2 cm. Assessment was performed by the three endoscopists with the highest kappa values (kv) in Study 1. Multivariate analysis was also performed to identify factors (age, BMI, cigarette smoking, and alcohol intake) related to CS. Results: In study 1, the kv for inter-observer agreement at the 3rd assessment were 0.85, 0.58, 0.50, and 0.78 for CS grades 0, 1, 2, and 3, respectively, while the kv for overall agreement was 0.68. Kv increased significantly after repeated assessment. In study 2, CS was classified as grade 0, 1, 2, and 3 in 40%, 28%, 17%, and 13% of men, respectively. The incidence of RE was 20% in men with grade 0 CS, 17% in grade 1, 25% in grade 2, and 30% in grade 3, showing significant differences. In addition, the incidence of RE was 10% in women with grade 0 CS, 3% in grade 1, 9% in grade 2, and 29% in grade 3 (P=0.09). Multivariate analysis showed that CS, BMI, and HH were independent risk factors for RE. Conclusion: Our new endoscopic classification of CS was shown to be both usable and meaningful. CS was identified as an independent risk factor for RE, suggesting that it could have a potential role in various functional gastrointestinal disorders.

Association between visceral fat and inflammatory cytokines in reflux esophagitis.

The results of several previous studies have suggested that abdominal obesity is an important risk factor for reflux esophagitis.1,2 Among factors related to obesity, visceral fat is more associated with erosive esophagitis than body mass index (BMI).3 Physiologic abnormalities related to prolonged esophageal acid exposure have been found to occur more frequently in obese individuals than in those with normal weight. Obese subjects revealed abnormal esophageal manometric findings such as nonspecific motility disorder, nutcracker esophagus, and hypotensive lower esophageal sphincter as the most common manometric results.4 Transient relaxations of the lower esophageal sphincter (TRLES) is also reported to be more common in patients with obesity. The main stimulus for TRLES is gastric distension especially in the gastric fundus.5 Pandofino et al6 reported esophageal manometric findings suggesting that the pressure morphology within and across the esophagogastric junction were altered in obesity, which could augment the flow of gastric juices into the esophageal lumen. This anatomical disruption of the esophagogastric junction results in further hiatal hernia formation. Esophageal mucosal injury is associated with increased exposure to gastric acid. However, maintenance of chronic esophageal mucosal inflammation and esophageal metaplasia such as Barrett’s esophagus (BE) or esophageal carcinoma in obese subjects have been proposed to increase inflammatory cytokines from visceral adipose tissue.7 The relationship between obesity and esophageal neoplasia may be due to alterations in the secretion of adipokines such as adiponection and leptin. Adiponection has an anti-inflammatory effect and stimulates apoptosis, which shows inverse relationship between obesity and adiponection.8 Leptin, a satiety hormone, is secreted by adipocytes and gastric chief cells. Esophageal epithelial cells express leptin receptors. In an esophageal adenocarcinoma cell line, leptin has been shown to stimulate cell proliferation and inhibit apoptosis via cyclooxygenase-2 activation of the epidermal growth factor receptor.9 Several studies have suggested a positive association between plasma leptin and BE.10,11 Kendall et al12 reported that a high serum leptin level is associated with an increased risk of BE among men, but not women. No previous reports have documented the relationship between circulating cytokines and reflux esophagitis (RE). Recently, Nam13 conducted an interesting case-control study that suggested circulating cytokines were correlated with the risk of erosive esophagitis. They used abdominal visceral fat instead of BMI and plasma leptin level had a positive correlation with RE. The visceral fat/total fat ratio was used as an obesity index because there is no standard cut off value for defining obesity. The results indicated that both visceral fat and the visceral fat/total fat ratio were positively correlated with IL-6, IL-8, and IL-1β, but were negatively associated with adiponectin. Leptin showed no association with visceral fat, but had a strong association with the visceral fat/total fat ratio. Only visceral fat/100 and leptin were positively correlated with RE after adjusted analysis for both inflammatory cytokines and obesity indexes. Despite the positive correlation of visceral fat and leptin with risk of RE, they did not classified reflux symptom strength or severity of esophagitis. Moreover, cytokine has its effect through ligand mediate reaction. Elevated plasma levels of cytokines do not always reflect cytokine bioactivity in inflamed regions. Checking the receptor expression and cytokine levels in target tissue provides more information about cytokine-ligand mediated responses.14,15 In conclusion, obesity is an important risk factor for developing gastroesophageal reflux disease. Abdominal visceral fat is a more useful obesity index for RE than BMI. To clarify the role of circulating cytokines in obese subjects with RE, further studies with large populations are needed, which will also help elucidate the pathophysiology between obesity and RE.

Characteristics of esophageal motility in patients with non-erosive reflux disease and reflux esophagitis

To explore the characteristics of esophageal motility in patients with non-erosive disease (NERD) and reflux esophagitis (RE). For this single-blind retrospective study, adult patients with typical reflux symptoms underwent esophageal manometry from January 2008 to December 2011. Their course of disease, age, gender, esophageal manometry, hiatal function and 24 h pH monitoring were analyzed by univariate and binary Logistic regression analyses. A total of 244 adult patients (RE = 85, NERD = 159) were enrolled into this study. Age and course of disease were significantly higher in RE group than those in NERD group ((50.7 ± 1.2) vs (46.5 ± 0.9) yrs,(4.8 ± 0.5) vs (3.4 ± 0.3) yrs, both P < 0.05) while no difference existed in gender (P > 0.05).Lower esophageal sphincter (LES) length, LES pressure, peristaltic contraction amplitude of distal esophageal body and rate of effective peristaltic contraction of distal esophageal body were significantly lower in RE group than those in NERD group ((1.91 ± 0.06) vs (2.19 ± 0.04) cm,(6.98 ± 0.31) vs (8.54 ± 0.31)mmHg,(56.76 ± 3.21) vs (75.57 ± 3.47) mmHg, 54.1% (46/85) vs 76.1% (121/159), all P < 0.05) . However, there was no inter-group difference in LES relaxation rate and upper esophageal sphincter (UES) function (both P > 0.05). Rate of hiatal hernia (HH) and hiatal flabby (HF) in RE group significantly increased versus NERD group (23.5% (20/85) vs 1.9% (3/159), 24.7% (21/85) vs 11.3% (18/159), both P < 0.05) . Positive rate of 24 h esophageal pH monitoring, reflux number and percent of reflux were significantly higher in RE group than those in NERD group (59.1% (26/44) vs 32.5% (38/117), 71.0 (13.5, 119.0) vs 25.0 (8.0, 56.0), 5.0% (0.4%, 10.9%) vs 1.1% (0.2%, 5.0%), all P < 0.05) . Binary Logistic regression analysis showed that LES length, rate of effective peristaltic contraction of distal esophageal body and HH were risk factors for RE (OR = 2.781,0.037, 21.722, 95%CI:1.057-7.313, 0.009-0.152, 5.433-86.845). Impaired anti-reflux barrier at esophagogastric junction and impaired clearance of esophageal body are important causative factors for RE. And abnormal anatomy in esophagogastric junction should raise alerts.

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease.

Background/AimsGastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients.MethodsFrom our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD.ResultsIn total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients.ConclusionsThe prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Relationship among symptoms, mucosal injury, and acid exposure in gastroesophageal reflux disease

Background Symptoms, endoscopy, and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD). Their relationship was meaningful for primary care physicians, but still unclear. Our research aimed to compare questionnaire, endoscopy, and pH monitoring and to analyze their correlations. Methods Three hundred patients who underwent the Reflux Disease Questionnaire (RDQ), endoscopy, and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled. We analyzed the characteristics of different investigations and their relationships. Results Male (OR for mild reflux esophagitis (RE) = 2.433, severe RE = 8.386), body mass index (BMI) (OR for mild RE = 1.222, severe RE = 1.297), and hernia (OR for mild RE = 6.059, severe RE = 17.547), were found to be the risk factors for RE; age (OR=1.074) was correlated with severe RE. The consistency of questionnaire, endoscopy, and pH monitoring was poor: RDQ did not agree well with pH monitoring (κ=0.061), nor with endoscopy (κ=0.044); pH monitoring did not agree well with endoscopy (κ=0.316). However, the severity of mucosa injury in RE was associated with pathological acid exposure (PAE): reflux episodes of &gt;5 minutes (P=0.035), the percentage time pH &lt;4 (P=0.017), and the DeMeester score (P=0.016) increased significantly in patients with severe RE. Chest pain had poor relationship with RE or PAE. Conclusions Male, age, BMI, and hernia were probably risk factors for esophagitis. RDQ, endoscopy, and pH monitoring have their own focus and reinforce each other in diagnosis. Of the GERD symptoms, chest pain had negative correlation with RE or PAE.

Prevalence of reflux esophagitis among patients undergoing endoscopy in a secondary referral hospital in Giza, Egypt

BackgroundGastro-esophageal reflux disease (GERD) is one of the most prevalent diseases seen in western countries. The prevalence of GERD is lower in the Asian population and the spectrum of the disease is mild. Data from Africa and the Middle East are sparse. AimThe aim of the study was to determine the prevalence, severity and risk factors of reflux esophagitis (RE) among patients undergoing endoscopy in a secondary referral hospital in Egypt. Materials and methodsThis was a retrospective study. Data on patients presenting with gastro-esophageal reflux symptoms (RS) and scheduled for upper gastrointestinal endoscopy between January 2000 and January 2013 were collected. ResultsFour hundred and thirty-three patients were assessed. Two hundred and fifty-four (59%) were male. Ages ranged from 18 to 85 years, mean 45 ± 15 years. One hundred and forty-four patients (33%) had a history of smoking, 120 (28%) were taking aspirin or non-steroidal anti-inflammatory drugs and 8 (2%) were consuming alcohol. The duration of RS ranged from one month to 20 years, mean 21 ± 30 months. One hundred and forty-six patients (34%) had the RS daily, 70 (16%) classified RS as severe intensity and 99 (23%) had acid regurgitation.One hundred and six patients (24%) were found to have RE. Ninety-eight of them (23%) showed grade 1. Barrett’s esophagus (BE) was diagnosed in seven patients (2%) and esophageal stricture in one (0.2%). One hundred and four patients (24%) had hiatus hernia (HH), 16 (4%) gastric ulcers and 45 (10%) duodenal ulcers. In multivariate analysis, male sex and HH were two independent risk factors for the development of RE. ConclusionThe prevalence of RE is low among patients undergoing endoscopy. Most of the patients had a mild degree of esophagitis. BE and stricture were rarely seen. Male sex and HH were risk factors of RE.

Investigation of Dietary Habits and Upper Gastrointestinal Diseases as Risk Factors for Reflux Esophagitis

Investigation of Dietary Habits and Upper Gastrointestinal Diseases as Risk Factors for Reflux Esophagitis

Vegetarianism as a Protective Factor for Reflux Esophagitis: A Retrospective, Cross-Sectional Study Between Buddhist Priests and General Population

Several risk factors for reflux esophagitis, such as smoking, alcohol consumption, obesity, and metabolic syndrome, are recognized. But vegetarianism as a protective factor for reflux esophagitis has not been reported. The aim of this study is to elucidate the protective effect of vegetarianism for reflux esophagitis. This is a cross-sectional study that compared the prevalence of reflux esophagitis of 148 Buddhist priests, who are obligatory vegetarians with that of age- and sex-matched controls who underwent health checkups in a health promotion center. The prevalence of reflux esophagitis was higher in the control group than in the Buddhist priest group (21.6 vs 12.2 %). Weight, body mass index, waist circumference, waist-to-hip ratio, and abdominal adipose tissue area were higher and high density lipoprotein (HDL) cholesterol and total cholesterol were lower in the Buddhist priest group. The prevalence of metabolic syndrome was higher in the Buddhist priest group than the control group (30.4 vs 17.6 %). In univariate analysis, male sex (odds ratio [OR] = 3.325; 95 % confidence interval [CI], 1.659-6.666), current smoking (OR = 3.37; 95 % CI, 1.439-7.881), alcohol consumption (OR = 2.75; 95 % CI, 1.375-5.481), waist circumference (OR = 1.99; 95 % CI, 1.062-3.739), negative for Helicobacter pylori IgG antibody (OR = 1.89; 95 % CI, 1.018-3.491) and non-vegetarianism (OR = 1.99; 95 % CI, 1.062-3.739) were associated with reflux esophagitis. According to multivariate analysis, male sex (OR = 3.44; 95 % CI, 1.698-6.970), non-vegetarianism (OR = 2.08; 95 % CI, 1.086-3.974) and negative H. pylori IgG antibody (OR = 1.96; 95 % CI, 1.039-3.712) were significantly associated with reflux esophagitis. A non-vegetarian diet is associated with reflux esophagitis.

Differences in the risk factors of reflux esophagitis according to age in Korea

The prevalence of gastroesophageal reflux disease in Korea has been believed to be low, but the incidence of gastroesophageal reflux disease in Korea is expected to increase because of the longer life expectancy and more ingestion of westernized food. The aim of this study was to report differences in the risk factors of reflux esophagitis (RE) according to age in Korea. We prospectively recruited the subjects who had RE among those who visited a health promotion center for upper gastrointestinal cancer surveillance at Hallym Medical Center (five institutions) between January 2008 and February 2009. The enrolled study participants comprised 742 subjects with RE and 1484 healthy controls. The independent risk factors of RE in young and adult group were male sex, smoking, coffee, body mass index ≥ 25, hiatal hernia, and Helicobacter pylori negativity. The risk factors of RE in elderly group were smoking, coffee, and hiatal hernia. The risk factors for RE according to age group were found to differ. In elderly group, Helicobacter pylori infection was not a significant protective factor contrary to young and adult groups.

Endoscopic Reflux Esophagitis and Helicobacter pylori Infection in Young Healthy Japanese Volunteers

Background/Aims: The prevalence of endoscopic esophagitis in young Japanese individuals is not fully apparent. The aim of this study was to determine the prevalence of reflux esophagitis (RE) and Helicobacter pylori infection and their relationship in young healthy Japanese volunteers. Methods: Upper gastrointestinal endoscopy was performed in 242 young healthy Japanese medical students (age range 22–29 years, mean 23.2 years) at Saga Medical School between 2008 and 2010. H. pylori infection was determined by detecting urinary IgG antibodies to H. pylori. Results:H. pylori antibodies were detected in 30 of the 242 subjects (12.4%). All 30 subjects had endoscopic chronic gastritis without peptic ulcers. Endoscopic RE was present in 27 of the 242 subjects (11.2%), corresponding to grade A in 19 subjects (7.9%), grade B in 7 (2.9%) and grade C in 1 (0.4%). Only 1 subject with RE was H. pylori-positive; the other 26 subjects with esophagitis were H. pylori-negative. We found no risk factors for H. pylori infection, but a risk factor for endoscopic esophagitis was alcohol consumption. Conclusion: The prevalence of H. pylori infection and endoscopic RE was 12.4 and 11.2%, respectively, in young healthy Japanese volunteers. Alcohol consumption was a risk factor for RE.

逆流性食道炎の危険因子の検討 : メタボリックシンドローム, 症状に関連しての検討

逆流性食道炎の危険因子の検討 : メタボリックシンドローム, 症状に関連しての検討

The association of metabolic syndrome with reflux esophagitis: a case-control study

Obesity has been associated with reflux esophagitis. However, the association of metabolic syndrome with reflux esophagitis remains unknown. A case-control study of 372 subjects undergoing upper endoscopy during health checkups was conducted (182 patients with reflux esophagitis vs 190 age and gender-matched controls). We further measured their height, weight, waist circumference, hip circumference, blood pressure, triglyceride, high-density lipoprotein, and fasting blood glucose. Multivariable linear regression analysis was used to identify the independent risk factors associated with the presence of reflux esophagitis. Reflux esophagitis cases showed higher mean waist circumference (81.37 ± 0.68 vs 79.36 ± 0.70, P < 0.05), waist hip ratio (0.86 ± 0.01 vs 0.84 ± 0.01, P < 0.05) and fasting blood glucose (5.59 ± 0.10 vs 5.32 ± 0.08, P < 0.05) than those in controls. When adjusted for gender and age, multivariate analysis demonstrated that there was a positive dose-response relationship between reflux esophagitis and waist hip ratio (men: OR 3.41, 95% CI 1.52-7.62, women: OR 3.37, 95% CI 1.61-7.06), triglyceride (OR 2.07, 95% CI 1.12-3.82), fasting blood glucose (OR 1.81, 95% CI 1.12-2.94), and metabolic syndrome (OR 2.01, 95% CI 1.15-3.50), there was an inverse dose-response relationship between reflux esophagitis and high-density lipoprotein for men (OR 0.36, 95% CI 0.15-0.85). High waist hip ratio, triglyceride, fasting blood glucose, and metabolic syndrome were associated with increased risk factors for reflux esophagitis while high high-density lipoprotein for men correlated with a reduced risk of reflux esophagitis.

Large Waist Circumference Is a Risk Factor for Reflux Esophagitis in Japanese Males

Background/Aims: The prevalence of reflux esophagitis, which might lead to development of Barrett’s esophagus and esophageal adenocarcinoma, has been increasing. The aim of this study was to assess risk factors for reflux esophagitis. Methods: We conducted a cross-sectional study of 1,495 Japanese subjects undergoing health checkups (822 males and 673 females; median age 50 years) at a tertiary care center. Results: One hundred and twenty-seven subjects (8%) had reflux esophagitis and hiatal hernia was observed in 292 subjects (20%). Reflux esophagitis (13 vs. 3%) and hiatal hernia (28 vs. 9%) were more frequent in males than females. Significant differences in clinical backgrounds were observed between females and males. Multivariate logistic regression analyses revealed that hiatal hernia (OR 6.63, 95% CI 2.47–17.8; p = 0.0002) was associated with reflux esophagitis in females. In males, age (per 1-year increment: OR 0.96, 95% CI 0.94–0.99; p = 0.007), hiatal hernia (OR 3.16, 95% CI 2.05–4.87; p < 0.0001) and waist circumference (per 1-cm increase: OR 1.09, 95% CI 1.02–1.15; p = 0.006) were associated with reflux esophagitis. Conclusions: Abdominal obesity may be an important risk factor for reflux esophagitis in males compared with females.

Obesity Is Not a Risk Factor in Children With Reflux Esophagitis: A Retrospective Analysis of 738 Children

Obesity has been associated with various gastrointestinal diseases in children, but the role of obesity in gastroesophageal reflux disease (GERD) has not been clearly established. The aim of the study was to investigate whether obesity and/or being overweight are risk factors for reflux esophagitis in children. A retrospective analysis of endoscopy charts was reviewed. Demographic, weight, height, and histology results were obtained from each patient. The body mass index (BMI) and BMI Z-score were calculated according to known formula. The diagnosis of GERD was established by histology. The charts of 738 children were reviewed; of these, 345 (47%) children were overweight or obese. Histological findings compatible with GERD were found in 254 (65%) children with normal weight, 111 (69%) overweight children, and 126 (68%) obese children (P > 0.05). Among those reviewed, the mean age of children with normal weight was significantly younger than that of overweight or obese children (P = 0.0001). A single variant analysis showed a significant association between GERD and male gender (P = 0.0001). Multivariant analysis (gender, age, and BMI Z-score) showed that GERD was significantly associated with male gender (P < 0.0001), but not with age (P = 0.443) or BMI Z-score (P = 0.098). In symptomatic children with histologically proven GERD, only male gender was an independent risk factor for GERD, not obesity or being overweight. Large, prospective studies in children that capture a larger spectrum of GERD are clearly warranted.