Background & Aims: Aside from chronic reflux, the etiology of Barrett’s esophagus (BE) remains largely unknown. This case-control study investigated body mass index (BMI), central adiposity, and cigarette smoking and risk of BE. Methods: Washington residents newly diagnosed with specialized intestinal metaplasia on at least 1 of 4 esophageal biopsy specimens taken at community gastroenterology clinics (cases [n = 193]) were compared with matched population controls (n = 211). Case subgroups included those with any visible columnar epithelium (visible BE) and those with at least 2 cm of columnar epithelium (long-segment BE [LSBE]). Interviewers conducted personal interviews and took anthropometric measurements. Results: All measures of central adiposity were strongly related to BE risk, particularly for LSBE. For the high category of waist-to-hip ratio (WHR), the adjusted odds ratios were 2.4 (95% confidence interval [CI]: 1.4–3.9) for all cases, 2.8 (95% CI: 1.5–5.1) for visible BE, and 4.3 (95% CI: 1.9–9.9) for LSBE. In contrast, the associations with BMI were weaker. When BMI and WHR were modeled simultaneously, the associations with BMI were greatly attenuated, whereas those with WHR remained strong. Further adjustment for frequency of heartburn did not change these results. Cigarette smoking moderately increased risk but with no evidence of a dose-dependent response or increasing strength by case group. Conclusions: These observations indicate the importance of identifying the mechanisms underlying obesity’s role in BE and esophageal adenocarcinoma, and suggest that weight loss might be a fruitful approach to the prevention of these diseases.
Section snippets
Study Participants
Case participants were selected from among western Washington residents aged 20–80 years without previously diagnosed BE who underwent an upper endoscopy for the investigation of refractory GERD symptoms at 1 of 4 community gastroenterology clinics between October 1, 1997, and September 30, 2000. Potential participants were recruited in conjunction with their endoscopy visit. Those consenting had 4-quadrant biopsy specimens taken from the tubular esophagus just distal to the squamocolumnar
Results
Table 1 presents selected sociodemographic characteristics of cases and controls. Age, gender, race, and Hispanic origin were similarly distributed. There was a slightly higher percentage of college-educated controls, as well as a higher percentage of controls in the highest income bracket. Of 197 cases with SIM, 97 were VBE cases, and, of those VBE cases, 54 were cases of LSBE.
The association between the 3 cases groups (SIM, VBE, and LSBE) and the various measures of adiposity are presented in
Discussion
In this case-control study, we observed that measures of central adiposity, including WHR, WTR, and WC, were strong and significant risk factors for BE after taking into account the potential confounding effects of age, gender, education, race, alcohol consumption, and cigarette smoking history. Additional adjustment for the effects of BMI had minimal effects on the strength of the associations between BE and measures of central obesity. In contrast, the association between risk of BE and BMI
Changing patterns in the incidence of esophageal and gastric carcinoma in the United States
Cancer
(1998)
J. Jeon et al.
Age effects and temporal trends in adenocarcinoma of the esophagus and gastric cardia (United States)
Cancer Causes Control
(2006)
H. Pohl et al.
The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence
J Natl Cancer Inst
(2005)
J. Lagergren et al.
Association between body mass and adenocarcinoma of the esophagus and gastric cardia
Ann Intern Med
(1999)
C. Samanic et al.
Relation of body mass index to cancer risk in 362,552 Swedish men
Cancer Causes Control
(2006)
R.J. MacInnis et al.
Body size and composition and the risk of gastric and oesophageal adenocarcinoma
Int J Cancer
(2006)
H. Hampel et al.
Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications
Ann Intern Med
(2005)
W.H. Chow et al.
Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia
J Natl Cancer Inst
(1998)
B.C. Jacobson et al.
Body-mass index and symptoms of gastroesophageal reflux in women
N Engl J Med
(2006)
L. Murray et al.
Relationship between body mass and gastro-oesophageal reflux symptoms: The Bristol Helicobacter Project
Int J Epidemiol
(2003)
M. Nilsson et al.
Obesity and estrogen as risk factors for gastroesophageal reflux symptoms
JAMA
(2003)
D.J. Stein et al.
The association of body mass index with Barrett’s oesophagus
Aliment Pharmacol Ther
(2005)
K.J. Smith et al.
Interactions among smoking, obesity, and symptoms of acid reflux in Barrett’s esophagus
Cancer Epidemiol Biomarkers Prev
(2005)
H.B. El-Serag et al.
Abdominal obesity and the risk of Barrett’s esophagus
Am J Gastroenterol
(2005)
T.L. Vaughan et al.
Nonsteroidal anti-inflammatory drug use, body mass index, and anthropometry in relation to genetic and flow cytometric abnormalities in Barrett’s esophagus
Gastroesophageal reflux disease (GERD) is often seen in obese patients. Many studies reported a positive association between GERD and obesity.1–11 A recent meta-analysis showed that obesity (BMI≥30 kg/m2) is one of the risk factors for GERD together with age, smoking, and nonsteroidal antiinflammation drug/aspirin use. Its odds ratio was 1.73 (95% CI: 1.46–2.06) compared to nonobese individuals. A dose-dependent association was shown between reflux symptoms and BMI (i.e., larger BMI more frequent or severe reflux symptoms),1–4,10 and two longitudinal studies found that weight gain during approximately 10 years increased the risk of developing reflux symptoms.3,8 Complications of GERD such as reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma are also related to obesity.7,10,12 The mechanisms by which obesity causes GERD can be explained by its effects on structural and physiological functions of the gastroesophageal antireflux barrier.
2021, Clinics and Research in Hepatology and Gastroenterology
Conflicting evidence exists regarding the effect of NSAIDs on the risk of Barrett’s esophagus. The purpose of this study is to systematically assess this effect through a meta-analysis.
Accordingly, clinical studies on NSAID use and Barrett’s esophagus risk were searched on PubMed, Embase, and the Cochrane Library. Following this, meta-analyses were conducted using the RevMan 5.3 software. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were used as the effect size.
Seven eligible studies (one cohort study and six case-control studies) were included for the present meta-analysis by adopting a fixed-effect model, which demonstrated that NSAIDs could reduce Barrett’s esophagus risk (OR: 0.84, 95%CI:0.75−0.94, P＜0.05). Moreover, subgroup analyses done according to sex showed that NSAIDs could reduce Barrett’s esophagus risk in females (OR 0.85; 95% CI 0.73–0.99; P = 0.04), without heterogeneity between studies (P = 1.00 and I2 = 0%). However, this relationship was not evident in males (OR 0.85; 95% CI 0.68–1.07; P = 0.16).
Overall, this meta-analysis provided high quality evidence that use of NSAIDs is associated with a reduced risk of Barrett’s esophagus. However, the presence of a sex-dependent difference remains to be clarified.
The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication use, while a minority have implemented objective functional measurements.
To better comprehend the pathophysiological mechanisms involved in the genesis of GERD after SG.
University Hospital, Italy.
A total of 21 patients affected by morbid obesity and eligible for SG were prospectively enrolled in the present study. Patients were evaluated by means of endoscopy, high-resolution manometry (HRM), 24-hour pH monitoring, and the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire.
Follow-up was completed at least 1 year post operation (mean follow-up, 14.3 ± 2.1 mo) by 19 patients. Body mass index decreased from 41.2 ± .9 to 26.8 ± .8 kg/m2 (P < .001). Distal contractile integral significantly decreased from 2772.8 ± 399.9 mm Hg/s/cm to 2060.4 ± 338.9 mm Hg/s/cm (P = .01). The 24-hour pH monitoring showed an overall reduction tendency of acid reflux, although this was not statistically significant. All analyzed endoscopic findings withstood substantial pejorative modifications after SG (P < .01). Distal contractile integral values at baseline predicted postoperative Z-line upward migration; HRM, distal latency, and DeMeester score at baseline predicted the development of erosive esophagitis at follow-up, by bootstrap estimates of a logistic regression.
Postoperative GERD-related esophageal sequelae should be carefully considered after SG. Our results demonstrate how acid reflux does not seem to play a relevant role in the pathophysiology of post-SG GERD. Baseline HRM can help stratify the risk of developing erosive esophagitis and Z-line upward migration after SG, while postoperative endoscopic surveillance should be encouraged regardless of the presence or absence of symptoms.
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
