title: Body mass index, chronic atrophic gastritis and heartburn: a population-based study among 8936 older adults from Germany.
abstract: BACKGROUND
  Obesity and overweight have been positively related to gastro-oesophageal reflux disease (GERD). It has been suggested that this relationship is as a consequence of an increased gastric acid reflux, which is caused by an enhanced intra-abdominal pressure.
  
  
  OBJECTIVE
  To assess potential interaction of the association between body mass index (BMI) and GERD by chronic atrophic gastritis, which goes along with decreased acid production.
  
  
  METHODS
  In the baseline examination of ESTHER, a study conducted in 9953 older adults in Saarland, information on frequency of heartburn, potential risk factors and medical history was obtained by self-administered standardized questionnaire. Serological measurements of pepsinogen I and II were taken for definition of chronic atrophic gastritis.
  
  
  RESULTS
  In total, 2565 (28.7%) of the included subjects experienced heartburn within the previous 4 weeks. A pronounced dose-response relationship was observed between BMI and heartburn occurrence (P < 0.001) among people without chronic atrophic gastritis, but not among people with chronic atrophic gastritis (P-value for interaction = 0.018). Obese/overweight people with chronic atrophic gastritis had a much lower risk of heartburn compared with obese/overweight people without chronic atrophic gastritis (OR = 0.31, 95% CI = 0.24-0.40).
  
  
  CONCLUSIONS
  Our results are consistent with the hypothesis that BMI is related positively to GERD symptoms by its impact on acid reflux.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany. gaolei615@sohu.com
authors.forename: L
authors.initials: L
authors.lastname: Gao
authors.forename: M N
authors.initials: MN
authors.lastname: Weck
authors.forename: D
authors.initials: D
authors.lastname: Rothenbacher
authors.forename: H
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005744:Gastric Acid; D005757:Gastritis, Atrophic / Q000209:etiology*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006356:Heartburn / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D020116:Pepsinogen A / Q000378:metabolism; D020115:Pepsinogen C / Q000378:metabolism; D015995:Prevalence; D012698:Serologic Tests; D011795:Surveys and Questionnaires
chemical_list: D020115:Pepsinogen C; D020116:Pepsinogen A