Skip to main content

Advertisement

SpringerLink
Log in

Body Mass Index is Associated with Barrett Esophagus and Cardiac Mucosal Metaplasia

  • Original Paper
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

A positive association between body mass index (BMI) and risk of esophageal adenocarcinoma has been reported. Barrett esophagus (BE) is a precursor lesion for esophageal adenocarcinoma. Cardiac mucosa (CM) and BE are both reflux-induced metaplastic columnar epithelia in the esophagus. We investigated the association between BMI and BE/CM in a case-control study. A total of 174 BE patients, 333 CM patients, and 274 controls were included in this study. Multivariate logistic regression methods were used to estimate odds ratios (OR) for BE or CM associated with BMI. Linear regression analysis was employed to examine the relationship between length of columnar lined esophagus (CLE) and BMI. A dose-dependent relationship was found between BMI and BE (P=.0004). The multivariate-adjusted OR for BE was 3.3 (95% confidence interval [CI], 1.6–6.7) when obese individuals (BMI ≥30 kg/m2) were compared to lean individuals (BMI < 22 kg/m2). Similarly, a dose-dependent relationship was found between BMI and CM (P=.03). The multivariate-adjusted OR for CM comparing obese to lean persons was 1.8 (95% CI, 1.04–3.10). The length of CLE was positively related to BMI (P=.04). In conclusion, BMI is associated with BE and CM and appears to act early in the sequence of events leading from gastroesophageal reflux disease to metaplasia (CM and BE) to dysplasia and finally to adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yang PC, Davis S (1988) Incidence of cancer of the esophagus in the US by histologic type. Cancer 61:612–617.

    Article  PubMed  CAS  Google Scholar 

  2. Powell J, McConkey CC (1990)Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 62:440–443.

    PubMed  CAS  Google Scholar 

  3. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289.

    Article  PubMed  CAS  Google Scholar 

  4. Zheng T, Mayne ST, Holford TR, Boyle P, Liu W, Chen Y, Mador M, Flannery J (1992) Time trend and age-period-cohort effects on incidence of esophageal cancer in Connecticut, 1935–89. Cancer Causes Control 3:481–492.

    Article  PubMed  CAS  Google Scholar 

  5. Hansson LE, Sparen P, Nyren O (1993) Increasing incidence of both major histological types of esophageal carcinoma among men in Sweden. Int J Cancer 54:402–407.

    Article  PubMed  CAS  Google Scholar 

  6. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR (1993) Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 104:510–513.

    PubMed  CAS  Google Scholar 

  7. Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053.

    Article  PubMed  CAS  Google Scholar 

  8. Bytzer P, Christensen PB, Damkier P, Vinding K, Seersholm N (1999) Adenocarcinoma of the esophagus and Barrett’s esophagus: a population-based study. Am J Gastroenterol 94:86–91.

    Article  PubMed  CAS  Google Scholar 

  9. Chow WH, Finkle WD, McLaughlin JK, Fankl H, Ziel HK, Fraumeni JF Jr (1995) The relation of gastroesophageal reflux diseases and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 274:474–477.

    Article  PubMed  CAS  Google Scholar 

  10. Farrow DC, Vaughan TL, Sweeney C, Gammon MD, Chow WH, Risch HA, Stanford JL, Hansten PD, Mayne ST, Schoenberg JB, Rotterdam H, Ahsan H, West AB, Dubrow R, Fraumeni JF Jr, Blot WJ (2000) Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer. Cancer Causes Control 11:231–238.

    Article  PubMed  CAS  Google Scholar 

  11. Terry P, Lagergren J, Ye W, Nyren O, Wolk A (2000) Antioxidant and cancers of the esophagus and gastric cardia. International J Cancer 87:750–754.

    Article  CAS  Google Scholar 

  12. Wang HH, Hsieh C, Antonioli DA (1994) Rising incidence rate of esophageal adenocarcinoma and use of pharmaceutical agents that relax the lower esophageal sphincter. Cancer Causes Control 5:573–578.

    Article  PubMed  CAS  Google Scholar 

  13. Vaughan TL, Farrow DC, Hansten PD, Chow WH, Gammon MD, Risch HA, Stanford JL, Schoenberg JB, Mayne ST, Rotterdam H, Dubrow R, Ahsan H, West AB, Blot WJ, Fraumeni JF Jr (1998) Risk of esophageal and gastric adenocarcinomas in relation to use of calcium channel blockers, asthma drugs, and other medications that promote gastroesophageal reflux. Cancer Epidemiol Biomarkers Prev 7:749–756.

    PubMed  CAS  Google Scholar 

  14. Kabat GC, Ng SK, Wynder EL (1993) Tobacco, alcohol intake, and diet in relationship to adenocarcinoma of the esophagus and gastric cardia. Cancer Causes Control 4:123–132.

    Article  PubMed  CAS  Google Scholar 

  15. Gammon MD, Schoenberg JB, Ahsan H, Risch HA, Vaughan TL, Chow WH, Rotterdam H, West AB, Dubrow R, Stanford JL, Mayne ST, Farrow DC, Niwa S, Blot WJ, Fraumeni JF Jr (1997) Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 89:1277–1284.

    Article  PubMed  CAS  Google Scholar 

  16. Lagergren J, Bergstrom R, Lindgren A, Nyren O 2000 The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia. Int J Cancer 85:340–346.

    Article  PubMed  CAS  Google Scholar 

  17. Wu AH, Wan P, Bernstein L 2001 A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinoma of the stomach and esophagus. Cancer Causes Control 12:721–732.

    Article  PubMed  CAS  Google Scholar 

  18. Chow WH, Blaser MJ, Blot WJ, Gammon MD, Vaughan TL, Risch HA, Perez-Perez GI, Schoenberg JB, Stanford JL, Rotterdam H, West AB, Fraumeni JF Jr (1998) An inverse relation between cagA+strains Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res 15:588–590.

    Google Scholar 

  19. Weston AP, Badr AS, Topalovski M, Cherian R, Dixon A, Hassanein RS 2000 Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett’s esophagus, Barrett’s dysplasia, and Barrett’s adenocarcinoma. Am J Gastroenterol 95:387–394.

    Article  PubMed  CAS  Google Scholar 

  20. Brown LM, Swanson CA, Gridley G, Swanson GM, Schoenberg JB, Greenberg RS, Silerman DT, Pottern LM, Hayes RB, Schwartz AG (1995) Adenocarcinoma of the esophagus: role of obesity and diet. J Natl Cancer Inst 87:104–109.

    Article  PubMed  CAS  Google Scholar 

  21. Vaughan TL, Davis S, Kristal A, Thomas DB (1995) Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 4:85–492.

    PubMed  CAS  Google Scholar 

  22. Ji BT, Chow WH, Yang G, McLaughlin JK, Gao RN, Zheng W, Shu XO, Jin F, Fraumeni JF Jr, Gao YT (1997) Body mass index and the risk of cancers of the gastric cardia and distal stomach in Shanghai, China. Cancer Epidemiol Biomarkers Prev 6:481–485.

    PubMed  CAS  Google Scholar 

  23. Chow WH, Blot WJ, Vaughan TL, Risch HA, Gammon MD, Stanford JL, Dubrow R, Schoenberg JB, Mayne ST, Farrow DC, Ahsan H, West AB, Rotterdam H, Niwa S, Fraumeni JF Jr (1998) Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 90:150–155.

    Article  PubMed  CAS  Google Scholar 

  24. Lagergren J, Bergstrom R, Nyren O (1999) Association between body mass index and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 130:883–890.

    PubMed  CAS  Google Scholar 

  25. Cheng KK, Sharp L, McKinney PA, Chilvers CED, Cook-Mozaffari P, Ahmed A, Day NE 2000 A case-control study of esophageal adenocarcinoma in women: a preventable disease. Br J Cancer 83:127–132.

    Article  PubMed  CAS  Google Scholar 

  26. Lagergren J 2000 Increased incidence of adenocarcinoma of the esophagus and cardia. Reflux and obesity are strong and independent risk factors according to the SECC study. Lakartidningen 97:1950–1953.

    PubMed  CAS  Google Scholar 

  27. Zhang ZF, Kurtz RC, Sun M, Karpeh M Jr, Yu GP, Gargon N, Fein JS, Georgopoulos SK, Harlap S (1996) Adenocarcinoma of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors. Cancer Epidemiol Biomarkers Prev 5:761–768.

    PubMed  CAS  Google Scholar 

  28. Reid BJ 1991 Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am 20:817–834.

    PubMed  CAS  Google Scholar 

  29. Chandrasoma PT, Der R, Ma Y, Dalton P, Taira M 2000 Histology of the gastroesophageal junction: an autopsy study. Am J Surg Pathol 24:402–409.

    Article  PubMed  CAS  Google Scholar 

  30. Chandrasoma PT, Lokuhetty DM, Demeester TR, Bremmer CG, Peters JH, Oberg S, Groshen S 2000 Definition of histologic changes in gastroesophageal reflux disease. Am J Surg Pathol 24:344–351.

    Article  PubMed  CAS  Google Scholar 

  31. Chandrasoma P 2005 Controversies of the cardiac mucosa and Barrett’s esophagus. Histopathology 46:361–373.

    Article  PubMed  CAS  Google Scholar 

  32. Der R, Tsao-Wei DD, DeMeester T, Peters J, Groshen S, Lord RVN, Chandrasoma P 2001 Carditis: a manifestation of gastroesophageal reflux disease. Am J Surg Pathol 25:245–252.

    Article  PubMed  CAS  Google Scholar 

  33. Chandrasoma PT, Der R, Dalton P, Kobayashi G, Ma Y, Peters J, Demeester TR 2001 Distribution and significance of epithelial types in columnar lined esophagus. Am J Surg Pathol 25:1188–1193.

    Article  PubMed  CAS  Google Scholar 

  34. Sampliner RE (1998) Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 93:1028–1031.

    Article  PubMed  CAS  Google Scholar 

  35. Breslow NE, Day NE (1980) Statistical methods in cancer research. Volume I—The analysis of case-control studies. IARC Scientific Publications, Lyon, pp 5–338.

    Google Scholar 

  36. Epilog plus. Statistics package for epidemiology and clinical trials. Epicenter Software, Pasadena, CA, (1999).

  37. Lagergren J, Bergstrom R, Lindgren A, Nyren O (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831.

    Article  PubMed  CAS  Google Scholar 

  38. Locke GRIII, Tally NJ, Fett SL, Zinsmeister AR, Melton LJ (1999) Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 106:642–649.

    Article  PubMed  Google Scholar 

  39. Spechler SJ, Zeroogian JM, Wand HH, Antonioli DA, Goyal RK (1995) The frequency of specialized intestinal metaplasia at squamo-columnar junction varies with the extent of columnar epithelial lining in esophagus. Gastroenterol 108:A224.

    Google Scholar 

  40. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL (1994) Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 272:205–211.

    Article  PubMed  CAS  Google Scholar 

  41. Seidell JC, Flegal KM: Assessing obesity (1997) classification and epidemiology. Br Med Bull 53:238–252.

    PubMed  CAS  Google Scholar 

  42. National Center for Health Statistics (1999) Prevalence of overweight and obesity among adults: United States. National Center for Health Statistics, Hyattsville, MD.

    Google Scholar 

  43. Day JP, Richter JE (1990) Medical and surgical conditions predisposing to gastroesophageal reflux disease. Gastroenterol Clin North Am 19:587–607.

    PubMed  CAS  Google Scholar 

  44. Anderson JE, Yim KB, Crowell MD (1999) Prevalence of gastroesophageal reflux disease in peritoneal dialysis and hemodialysis patients. Adv Perit Dial 15:75–78.

    PubMed  CAS  Google Scholar 

  45. Fraser-Moodie CA, Norton B, Gornall C, Magnago S, Weale AR, Holmes GK (1999) Weight loss has as independent beneficial effect on symptoms of gastro-oesophageal reflux in patients overweight. Scand J Gastroenterol 34:337–340.

    Article  PubMed  CAS  Google Scholar 

  46. Lundell L, Ruth M, Sandberg N, Bove-Nielsen M (1995) Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 40:1632–1635.

    Article  PubMed  CAS  Google Scholar 

  47. Kjellin A, Ramel S, Rossner S, Thor K (1996) Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 31:1047–1051.

    Article  PubMed  CAS  Google Scholar 

  48. Lagergren J, Bergstrom R, Nyren O 2000 No relation between body mass index and gastro-oesophageal reflux symptoms in a Swedish population based study. Gut 47:26–29.

    Article  PubMed  CAS  Google Scholar 

  49. Jankowski JA, Wright NA, Meltzer SJ, Triadafilopoulos G, Geboes K, Casson AG, Kerr D, Young LS (1999) Molecular evolution of the metaplasia-dysplasia-adenocarcinoma sequence in the esophagus. Am J Pathol 154:965–973.

    PubMed  CAS  Google Scholar 

  50. Ransford RA, Jankowski JA 2000Genetic versus environmental interactions in the oesphagitis-metaplasia-dysplasia-adenocarcinoma sequence (MCS) of Barrett’s esophagus. Acta Gastroenterol Belg 63:18–21.

    PubMed  CAS  Google Scholar 

  51. Olvera M, Wickramasinghe K, Brynes R, Bu X, Ma Y, Chandrasoma P 2005 ki67 expression in different epithelial types in columnar lined oesophagus indicates varying levels of expanded and aberrant proliferative patterns. Histopathology 47:132–140.

    Article  PubMed  CAS  Google Scholar 

  52. Katada N, Hinder RA, Smyrk TC, Hirabayashi N, Perdikis G, Lund RJ, Woodward T, Klingler PJ (1997) Apoptosis is inhibited early in the dysplasia-carcinoma sequence of Barrett esophagus. Arch Surg 132:728–733.

    PubMed  CAS  Google Scholar 

  53. Joint FAO/WHO/UNU Expert Consultation (1985) Energy and protein requirements. World Health Organization Technical Report Series No. 724. World Health Organization, Geneva, pp 1–67.

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Pathology, University of Southern California, Keck School of Medicine and LAC+USC Medical Center, Room 16-905, 1200 N. State Street, Los Angeles, California, 90033, USA

    Xiangdong Bu, Yanling Ma, Roger Der & Parakrama T. Chandrasoma

  2. Department of Surgery, University of Southern California, Keck School of Medicine and LAC+USC Medical Center, Los Angeles, California, USA

    Tom Demeester

  3. Department of Preventive Medicine, University of Southern California, Keck School of Medicine and LAC+USC Medical Center, Los Angeles, California, USA

    Leslie Bernstein

Authors
  1. Xiangdong Bu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanling Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger Der
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tom Demeester
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leslie Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Parakrama T. Chandrasoma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Parakrama T. Chandrasoma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bu, X., Ma, Y., Der, R. et al. Body Mass Index is Associated with Barrett Esophagus and Cardiac Mucosal Metaplasia. Dig Dis Sci 51, 1589–1594 (2006). https://doi.org/10.1007/s10620-006-9118-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9118-0

Keywords

Search

Navigation