Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya 663-8501, Japan.
BMC Gastroenterol. 2013 Sep 26;13:143. doi: 10.1186/1471-230X-13-143.
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.
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.
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.
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.
肥胖与日本人群中 Barrett 食管（BE）的关系尚不清楚。本研究旨在探讨 BE 的流行情况及其相关危险因素。
对 1581 例连续接受上消化道内镜检查的个体进行横断面研究。评估内镜疑似 BE（ESBE）的患病率。通过体重指数（BMI，≥25kg/m2）和腰围（WC）（男性，≥85cm；女性，≥90cm）评估肥胖。由于内镜诊断超短段 ESBE（<1cm）较困难且高度不可靠，因此本研究排除了这种类型的 ESBE。
在质子泵抑制剂（PPI）非使用者中，ESBE≥1cm 的患病率为 5.6%。单因素分析显示，男性和反流性食管炎（RE）与 BE 显著相关，而 BMI、WC 和反流症状则不然。多因素 logistic 回归分析显示，仅 RE（比值比[OR] 3.48，95%置信区间[CI] 1.89-6.41，p<0.0001）是 BE 的独立危险因素；肥胖和其他因素则不是。相比之下，RE（OR 5.67，p=0.0004）和大 WC（OR 5.09，p=0.0005）是 PPI 使用者 ESBE≥1cm 的显著危险因素。仅男性，而不是肥胖或其他危险因素，与 PPI 使用者中 RE 风险增加相关。
RE 而非肥胖可能与日本人群 ESBE 的风险具有独立相关性。此外，肥胖指标不是 RE 的独立危险因素。有趣的是，PPI 难治性 RE 和大 WC 是服用 PPI 的患者 ESBE≥1cm 的危险因素。
