Central Obesity as a Risk Factor for Non-Erosive Reflux Disease
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Purpose: Although 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 Methods: Comprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnairewas used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects accordingto propensity scores. Results: There 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 adjustingfor 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 multivariablelogistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001). Conclusion: Central 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).
Abstract
Purpose: Although 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 Methods: Comprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnairewas used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects accordingto propensity scores. Results: There 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 adjustingfor 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 multivariablelogistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001). Conclusion: Central 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).
참고문헌 (39)
- "An evidence-based appraisal of reflux disease management--the Genval Workshop Report", Gut, 44(Suppl 2), pp.S1~S16 (1999)
- Locke GR 3rd, "Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota", Gastroenterology, 112, pp.1448~1456 (1997)
- Moayyedi P, "Gastro-oesophageal reflux disease", Lancet, 367, pp.2086~2100 (2006)
- El-Serag HB, "Gastroesophageal reflux among different racial groups in the United States", Gastroenterology, 126, pp.1692~1699 (2004)
- El-Serag HB, "Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review", Gut, 63, pp.871~880 (2014)
- Kang MS, "Abdominal obesity is an independent risk factor for erosive esophagitis in a Korean population", J Gastroenterol Hepatol, 22, pp.1656~1661 (2007)
- Cho YS, "Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea", Am J Gastroenterol, 100, pp.747~753 (2005)
- Wong WM, "Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a populationbased study", Aliment Pharmacol Ther, 18, pp.595~604 (2003)
- Kim N, "The prevalence of and risk factors for erosive oesophagitis and non-erosive reflux disease: a nationwide multicentre prospective study in Korea", Aliment Pharmacol Ther, 27, pp.173~185 (2008)
- Kim KM, "Prevalence of gastroesophageal reflux disease in Korea and associated health-care utilization: a national population-based study", J Gastroenterol Hepatol, 27, pp.741~745 (2012)
- Tack J, "Prevalence of acid reflux in functional dyspepsia and its association with symptom profile", Gut, 54, pp.1370~1376 (2005)
- El-Serag HB, "Epidemiology of non-erosive reflux disease", Digestion, 78(Suppl 1), pp.6~10 (2008)
- Zagari RM, "Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: the Loiano-Monghidoro study", Gut, 57, pp.1354~1359 (2008)
- Oh SW, "Cut-off point of BMI and obesity-related comorbidities and mortality in middle-aged Koreans", Obes Res, 12, pp.2031~2040 (2004)
- 김철식, "Prevalence, Awareness, and Management of Obesity in Korea: Data from the Korea National Health and Nutrition Examination Survey (1998–2011)", Diabetes and Metabolism Journal, 38(1), pp.35~43 (2014), 대한당뇨병학회[DOI]
- Nilsson M, "Obesity and estrogen as risk factors for gastroesophageal reflux symptoms", JAMA, 290, pp.66~72 (2003)
- Delgado-Aros S, "Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study", Am J Gastroenterol, 99, pp.1801~1806 (2004)
- El-Serag HB, "Obesity is an independent risk factor for GERD symptoms and erosive esophagitis", Am J Gastroenterol, 100, pp.1243~1250 (2005)
- El-Serag HB, "Obesity increases oesophageal acid exposure", Gut, 56, pp.749~755 (2007)
- Labenz J, "Risk factors for erosive esophagitis: a multivariate analysis based on the ProGERD study initiative", Am J Gastroenterol, 99, pp.1652~1656 (2004)
- Nam SY, "Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women", Gastroenterology, 139, pp.1902~1911 (2010)
- 남수연, "Irritable Bowel Syndrome Is Associated With Gastroesophageal Reflux Symptom but Not Erosive Esophagitis", Journal of Neurogastroenterology and Motility (JNM), 19(4), pp.521~531 (2013), 대한소화기 기능성질환∙운동학회
- Jones R, "Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care", Aliment Pharmacol Ther, 30, pp.1030~1038 (2009)
- Lee SY, "Appropriate waist circumference cutoff points for central obesity in Korean adults", Diabetes Res Clin Pract, 75, pp.72~80 (2007)
- Armstrong D, "The endoscopic assessment of esophagitis: a progress report on observer agreement", Gastroenterology, 111, pp.85~92 (1996)
- D’Agostino RB Jr, "Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group", Stat Med, 17, pp.2265~2281 (1998)
- Fisher BL, "Obesity correlates with gastroesophageal reflux", Dig Dis Sci, 44, pp.2290~2294 (1999)
- Kahrilas PJ, "Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia", Gastroenterology, 118, pp.688~695 (2000)
- Jacobson BC, "Bodymass index and symptoms of gastroesophageal reflux in women", N Engl J Med, 354, pp.2340~2348 (2006)
- Beales IL, "Tumour necrosis factor alpha stimulates gastrin release from canine and human antral G cells: possible mechanism of the Helicobacter pylori-gastrin link", Eur J Clin Invest, 26, pp.609~611 (1996)
- Endo Y, "Induction by interleukin-1, tumor necrosis factor and lipopolysaccharides of histidine decarboxylase in the stomach and prolonged accumulation of gastric acid", Br J Pharmacol, 125, pp.842~848 (1998)
- Tilg H, "Visceral adipose tissue attacks beyond the liver:esophagogastric junction as a new target", Gastroenterology, 139, pp.1823~1826 (2010)
- Taylor RW, "Body mass index, waist girth, and waist-to-hip ratio as indexes of total and regional adiposity in women: evaluation using receiver operating characteristic curves", Am J Clin Nutr, 67, pp.44~49 (1998)
- Mason C, "Variability in waist circumference measurements according to anatomic measurement site", Obesity (Silver Spring), 17, pp.1789~1795 (2009)
- Corley DA, "Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms", Gut, 56, pp.756~762 (2007)
- Lee HL, "Association between erosive esophagitis and visceral fat accumulation quantified by abdominal CT scan", J Clin Gastroenterol, 43, pp.240~243 (2009)
- Ang TL, "A comparison of the clinical, demographic and psychiatric profiles among patients with erosive and non-erosive reflux disease in a multi-ethnic Asian country", World J Gastroenterol, 11, pp.3558~3561 (2005)
- Mishima I, "Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese", Scand J Gastroenterol, 40, pp.1005~1009 (2005)
- Rosaida MS, "Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study", Eur J Gastroenterol Hepatol, 16, pp.495~501 (2004)