Association Between GERD-related Erosive Esophagitis and Obesity
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. Journal of clinical gastroenterology
(Impact Factor: 3.5).
08/2008; 42(6):672-5. DOI: 10.1097/MCG.0b013e31806daf64
To date, many studies have reported on the association of obesity with gastroesophageal reflux disease (GERD), although none of these have been systematic. In light of this, we conducted this study to examine the association of obesity and GERD.
A total of 3363 patients underwent gastroscopy at Hanyang University Health Promotion Center. Among these patients, we prospectively examined patients who were diagnosed with GERD-related erosive esophagitis on endoscopy.
Multivariate analysis showed that the significant risk factors were waist-to-hip ratio (WHR), hiatal hernia, body mass index (BMI), and smoking. As compared with patients who had a WHR less than 0.8, the multivariate odds ratio for erosive esophagitis were 4.055 for a WHR more than 1.0 and 2.316 for a WHR of 0.8 to 1.0. As compared with patients who had a BMI of 20 to 22.5, the multivariate odds ratio for erosive esophagitis was 3.308 (95% confidence interval, 1.792 to 6.107) for a BMI greater than 30.
Obesity, especially abdominal obesity, was the significant risk factor for erosive esophagitis.
Available from: Yon Ju Ryu
- "In our study, the prevalence of RE in COPD was 30%, which is higher than that reported previously in the Korean general population (Table 6) [19,20,21,22] and Asia . Generally, the prevalence of GERD in Asia is known to be lower than that in Western countries [17,23]. "
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Gastroesophageal 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.
From 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.
In 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.
The 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.
Available from: PubMed Central
- "EE patients were reported to be older than NERD19 but our study showed that the age of EE group was similar to that of NERD and FH group, which was also observed in the previous Korean report.20 Female gender was predominant in NERD and FH in the present study, a frequent finding in functional disorders.21-23 Our study also showed that alcohol consumption, smoking history, the presence of hiatal hernia, BMI ≥ 25 kg/m2 and triglyceride levels (≥ 150 mg/dL) were significantly more common in patients with EE than in those with NERD and FH, supporting an association of high BMI24 or obesity with EE.25 In addition, hiatal hernia, a significant risk factor for EE, was found to be significantly associated with an increased BMI.26 On the other hand, anxiety and depression tended to be more prevalent in FH patients than in EE or NERD patients.20 "
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ABSTRACT: To compare gastroesophageal reflux disease (GERD) symptoms and response to proton pump inhibitor (PPI) in patients with erosive esophagitis (EE), non-erosive reflux disease (NERD) or functional heartburn (FH) using GERD impact scale (GIS) questionnaire.
Total 126 patients with GERD symptoms were diagnosed as EE (n = 62), NERD (n = 34) and FH (n = 30) by endoscopy, 24-hour esophageal pH testing and Bernstein test, prospectively. Analysis of risk factors and GIS questionnaire for GERD symptoms and quality of life were performed before and 8 weeks after PPI treatment.
EE group had a higher proportion of men, frequent alcohol consumption, smoking, hiatal hernia, body mass index ≥ 25 kg/m(2) and triglyceride levels (≥ 150 mg/dL) than the other groups (all P < 0.05). On the other hand, both psychiatric treatment and psychopharmacotherapy were more frequent in patients with FH than in those with EE and NERD (both P < 0.05). Among GERD symptoms, chest pain was more frequent in FH group than in EE and NERD groups (P < 0.05). Eating problems and limitation of productive daily activities occurred frequently in FH group and NERD group, respectively. GIS after 8 week PPI treatment showed improvement in all of the GERD symptoms in EE (all P < 0.05) and in acid regurgitation, epigastric pain and hoarseness in NERD group (all P < 0.05). In terms of quality of life, PPI treatment improved sleep disturbance in EE (P = 0.031) and limitation of productive activity in the NERD group (P = 0.001).
GIS questionnaire showed that different characteristics and symptoms improved after PPI therapy among patients with EE, NERD and FH, demonstrating the usefulness of the GIS questionnaire.
Available from: Sung Woo Jung
- "On the contrary, a study from a large integrated health care system suggested that GERD symptoms were positively associated with abdominal obesity as measured by the abdominal diameter independent of the BMI, in a Caucasian male population; however, these findings were not confirmed in African Americans and Asians.23 In Korea, recent studies have demonstrated that obesity, especially abdominal obesity, is a significant risk factor for erosive esophagitis in the patients who underwent upper endoscopy during health check-ups.10,32 Our study showed that the patients with newly developed erosive esophagitis had higher BMI and WC at endoscopic diagnosis than the patients without newly developed erosive esophagitis, which indicates that obesity including abdominal obesity is a significant risk factor for erosive esophagitis. "
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ABSTRACT: Obesity is reported to be associated with erosive esophagitis (EE). However, the temporal association of obesity and abdominal obesity with EE is unclear. We conducted this study to investigate the temporal association of obesity, especially abdominal obesity with EE.
Among 1,182 subjects who underwent health screening examinations including upper endoscopy in both 2003 and 2006, a total 1,029 subjects with a normal esophagogastric junction on upper endoscopy in 2003 were enrolled. All subjects completed questionnaires and anthropometric measurements were obtained twice by trained personnels. The patients with newly developed EE were compared to the subjects without newly developed EE.
Among 1,029 subjects, 42 (4.1%) were newly diagnosed with EE and 82 (8.0%) with hiatal hernia. The mean body mass index (BMI) in both examinations was significantly different between the two groups based on the development of erosive esophagitis (p<0.05 in both examinations). The mean waist circumference (WC) in both examinations was also significantly different between the two groups (p<0.01 in both examinations). The multivariate analysis demonstrated that EE was not associated with the BMI in 2003 and the increase of BMI; however, it was associated with the WC in 2003 (Odds ratio, 7.21; 95% CI, 1.78 to 29.19; >90 cm vs <80 cm).
Our study showed that abdominal circumference is an independent risk factor for EE, demonstrating a temporal relationship between abdominal obesity and EE.
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