Association between obesity and Barrett's esophagus in a Japanese population: a hospital-based, cross-sectional study.
BACKGROUND
The association between obesity and Barrett's esophagus (BE) in the Japanese population remains unclear. The prevalence of BE and its associated risk factors was examined.


METHODS
A cross-sectional study of 1581 consecutive individuals who underwent upper gastrointestinal endoscopy was conducted. The prevalence of endoscopically suspected BE (ESBE) was evaluated. Obesity was evaluated by body mass index (BMI, ≥ 25 kg/m2) and waist circumference (WC) (males, ≥ 85 cm; females, ≥ 90 cm). Because endoscopic diagnosis of ultra-short ESBE (<1 cm in extent) is difficult and highly unreliable, this type of ESBE was excluded from the study.


RESULTS
In proton pump inhibitor (PPI) non-users, the prevalence of ESBE ≥ 1 cm was 5.6%. In univariate analysis, male sex and reflux esophagitis (RE) were significantly associated with BE, but BMI, WC, and reflux symptoms were not. In multivariate logistic regression analysis, only RE (odds ratio [OR] = 3.48, 95% confidence interval [CI] 1.89-6.41, p < 0.0001) was an independent risk factor for BE; obesity and the other factors were not. In contrast, RE (OR 5.67, p = 0.0004) and large WC (OR 5.09, p = 0.0005) were significant risk factors for ESBE ≥ 1 cm in PPI users. Only male sex, but not obesity or the other risk factors, was associated with an increased risk of RE in patients not taking PPIs.


CONCLUSIONS
RE, but not obesity, may have an independent association with the risk of ESBE in the Japanese population. Furthermore, obesity measures were not independent risks for RE. Interestingly, PPI-refractory RE and large WC were risk factors for ESBE ≥1 cm in patients taking PPIs.
Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya 663-8501, Japan. watarij@hyo-med.ac.jp.
Jiro
J
Watari
Kazutoshi
K
Hori
Fumihiko
F
Toyoshima
Noriko
N
Kamiya
Takahisa
T
Yamasaki
Takuya
T
Okugawa
Haruki
H
Asano
Zhao Liang
ZL
Li
Takashi
T
Kondo
Hisatomo
H
Ikehara
Jun
J
Sakurai
Toshihiko
T
Tomita
Tadayuki
T
Oshima
Hirokazu
H
Fukui
Hiroto
H
Miwa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004942:Esophagitis, Peptic / Q000453:epidemiology*; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D056128:Obesity, Abdominal / Q000453:epidemiology; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D055105:Waist Circumference; D055815:Young Adult
D054328:Proton Pump Inhibitors