Chiba Hideyuki, Gunji Toshiaki, Sato Hajime, Iijima Kimiko, Fujibayashi Kazutoshi, Okumura Mitsue, Sasabe Noriko, Matsuhashi Nobuyuki, Nakajima Atsushi
Center for Preventive Medicine, NTT Medical Center Tokyo, Japan.
Intern Med. 2012;51(11):1293-9. doi: 10.2169/internalmedicine.51.7241. Epub 2012 Jun 1.
To investigate the impact of metabolic and lifestyle factors on erosive esophagitis in young adults.
A total of 5,069 people under the age of 40 years old were enrolled in a medical survey at our institute. People with a previous history of upper gastrointestinal tract surgery were excluded, as were individuals taking medication for reflux symptoms, peptic ulcers, or malignancies. Independent and significant predictors affecting the presence of erosive esophagitis were determined by multivariate analysis.
A total of 4,990 participants (male/female; 3,871/1,119, age; 33.9±3.9 years) were eligible. A total of 728 participants (14.6%) had erosive esophagitis. Male gender and increasing age were independent predictors for increased prevalence of erosive esophagitis (odds ratio=2.242 and 1.045. 95% confidence interval=1.613-3.117 and 1.019-1.072; p<0.001 and 0.001, respectively). Moderate-to-heavy alcohol consumption, light-to-moderate-to-heavy smoking, hypertension, hyperglycemia, and hiatal hernia each significantly and independently increased the risk for erosive esophagitis (odds ratio=1.499, 1.398, 1.353, 1.570, 1.884, 1.297, 1.562, and 3.213. 95% confidence interval=1.181-1.903, 1.040-1.880, 1.094-1.675, 1.250-1.971, 1.307-2.716, 1.074-1.566, 1.063-2.295, and 2.712-3.807; p=0.001, 0.027, 0.005, <0.001, 0.001, <0.001, 0.007, 0.023, and <0.001 respectively). Helicobacter pylori infection decreased the risk for erosive esophagitis (odds ratio=0.575, 95% confidence interval =0.436-0.759 p<0.001). Neither body mass index nor waist girth conferred increased risk of erosive esophagitis after adjusting for potential confounding factors.
Risk of erosive esophagitis in Japanese young adults was not increased by obesity, but it was increased by hiatal hernia and metabolic and lifestyle profiles including hypertension, hyperglycemia, alcohol consumption and smoking.
探讨代谢和生活方式因素对年轻成年人糜烂性食管炎的影响。
本研究所共有5069名40岁以下人群参与了一项医学调查。排除既往有上消化道手术史者，以及正在服用治疗反流症状、消化性溃疡或恶性肿瘤药物的个体。通过多因素分析确定影响糜烂性食管炎发生的独立且显著的预测因素。
共有4990名参与者（男/女；3871/1119，年龄；33.9±3.9岁）符合条件。共有728名参与者（14.6%）患有糜烂性食管炎。男性和年龄增长是糜烂性食管炎患病率增加的独立预测因素（优势比分别为2.242和1.045，95%置信区间分别为1.613 - 3.117和1.019 - 1.072；p值分别<0.001和0.001）。中度至重度饮酒、轻度至中度至重度吸烟、高血压、高血糖和食管裂孔疝均显著且独立增加糜烂性食管炎的风险（优势比分别为1.499、1.398、1.353、1.570、1.884、1.297、1.562和3.213，95%置信区间分别为1.181 - 1.903、1.040 - 1.880、1.094 - 1.675、1.250 - 1.971、1.307 - 2.716、1.074 - 1.566、1.063 - 2.295和2.712 - 3.807；p值分别为0.001、0.027、0.005、<0.001、0.001、<0.001、0.007、0.023和<0.001）。幽门螺杆菌感染降低了糜烂性食管炎的风险（优势比为0.575，95%置信区间为0.436 - 0.759，p<0.001）。在调整潜在混杂因素后，体重指数和腰围均未增加糜烂性食管炎的风险。
日本年轻成年人糜烂性食管炎的风险并非因肥胖而增加，而是因食管裂孔疝以及包括高血压、高血糖、饮酒和吸烟在内的代谢和生活方式因素而增加。
