麻豆传媒

Visceral fat obesity was the key risk factor in developing reflux erosive esophagitis among middle-age adults, Japanese researchers found in a cross-sectional study.

Incidence of erosive esophagitis was higher among adults ages 40 to 69 with visceral fat obesity compared to those without (61.2% vs 12.8%, respectively), and adults with visceral fat obesity had more than two times higher odds of developing the condition (OR 2.18, 95% CI 1.45-3.26), reported Shinya Ohashi, MD, PhD, and colleagues from the Kyoto University Hospital in Japan, in .

Additional significant risk factors for erosive esophagitis were gastric atrophy absence or closed-type and daily high-level alcohol consumption, according to the group.

In fact, 29% of participants had all three risk factors, and 86% of participants either had visceral fat obesity or drank at least 30 g of alcohol per day, they added.

Studying gastroesophageal reflux disease is important since it can cause chronic inflammation, resulting in a higher risk for patients to develop esophageal adenocarcinoma. Obesity is on the rise worldwide and a visceral fat area measurement can be used to assess its relationship with erosive esophagitis in age-specific participants, which previous studies have not evaluated, the authors said.

Obesity can also increase a patient's chance for developing gastroesophageal reflux disease, they said.

"The mechanism by which visceral fat obesity increases the incidence of reflux esophagitis most likely involves an increase in intra-abdominal pressure, because this increases esophageal acid exposure," the authors explained in response to findings. "Our results support the concept that visceral fat obesity might be involved in the development of esophageal hernia and the subsequent onset of reflux erosive esophagitis."

Researchers attempted to evaluate the usefulness of using abdominal CT to quantitatively measure visceral fat in studying its effects on gastrointestinal reflux disease. Factors related to obesity such as waist circumference, BMI, and visceral or subcutaneous or total fat area were assessed in association with reflux erosive esophagitis incidence.

The study consisted of 433 healthy adults ages 40-69 who visited a single medical center in Japan for a medical checkup. Median age was about 53, and 234 participants were men.

Researchers found a 27.3% erosive esophagitis prevalence among participants, as 45.3% of men and 6% of women had the condition.

All factors related to obesity, including BMI, total fat area, and waist circumference, were greater in participants with erosive esophagitis. Among participants with erosive esophagitis, 66.9% had visceral fat obesity. In addition, 53.3% of adults with erosive esophagitis had a high BMI (defined as 25 or higher).

"We categorized obesity using visceral fat obesity and BMI, and analyzed the incidence of erosive esophagitis in each category," Ohashi told 麻豆传媒. "For example, category B (BMI<25, [visceral fat area]>100), which is not identified as a high-risk group by traditional obesity criteria (BMI>25), is also at high risk for GERD. Thus, it may not be a surprising finding, but we showed the involvement of visceral fat obesity on GERD very clearly."

Erosive esophagitis was more prevalent in participants with heartburn than participants without heartburn (49.0% vs 24.3%). There were 22% of participants who had symptoms of heartburn and erosive esophagitis.

Interestingly, the authors identified two "negative risk factors" associated with erosive esophagitis: gastric atrophy open type (OR 0.29, 95% CI 0.13-0.66) and never-smoking history (OR 0.49, 95% CI 0.25-0.96).

Limitations of this study include excluding participants deemed "non-healthy" with any other illness. Therefore, further conclusions cannot be drawn for patients who have any pre-existing condition. This was also a single-center study with a limited population size of similar demographic backgrounds in Japan. Participants also only presented mild cases of erosive esophagitis.

Ohashi said in the future, he would like to show if reduction of visceral fat obesity prevents the development of GERD.

"I would like to construct a GERD-prediction score. I believe it would help to prevent GERD development," Ohashi said.

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