Asthma under control is inversely related with erosive esophagitis among healthy adults

Abstract

BackgroundSome recent studies suggested that reflux esophagitis is positively correlated with asthma. However, there are debates on this issue. The aim of this study is to clarify the true association between reflux esophagitis and asthma in a large population.MethodsMedical records of subjects who received health surveillance checkup between January 2005 and December 2011 were reviewed. Their endoscopic findings, medical history, body mass index, and smoking history were analyzed. Erosive esophagitis was defined as endoscopically detected mucosal break at the Z-line, irrespective of reflux symptom. Information about asthma history was obtained from their questionnaires and medical records.ResultsOut of the total 15,999 patients, 986 had erosive esophagitis and 376 had asthma. In this population, erosive esophagitis was inversely related with asthma in univariable analysis (OR, 0.586; 95% CI, 0.342–1.003, p = 0.049). In multivariable analysis, asthma was demonstrated as an independent negative risk factor for erosive esophagitis (OR, 0.472; 95% CI, 0.257–0.869, p = 0.016), under adjustment with age (OR, 1.000; 95% CI, 0.994–1.006, p = 0.977), male sex (OR, 2.092; 95% CI, 1.683–2.601, p < 0.001), body mass index (OR, 1.115; 95% CI, 1.090–1.141, p < 0.001), smoking (OR, 1.584; 95% CI, 1.318–1.902, p < 0.001), and urban residence (OR, 1.363; 95% CI, 1.149–1.616, p < 0.001). Likewise, erosive esophagitis was shown to be an independent negative risk factor for asthma (OR, 0.558; 95% CI, 0.324–0.960, p = 0.035) under adjustment with age (OR, 1.025; 95% CI, 1.015–1.034, p <0.001), male sex (OR, 0.861; 95% CI, 0.691–1.074, p = 0.185), and body mass index (OR, 1.067; 95% CI, 1.030–1.106, p < 0.001) in multivariable analysis.ConclusionsContrary to previous studies, this large scale data showed inverse association between erosive esophagitis and asthma. Further studies investigating the clear mechanism of this phenomenon are warranted.

Risk factors of asthma in the Asian population: a systematic review and meta-analysis

“…Of these, 58 studies have observed male subjects having a higher asthma susceptibility as compared with that of the female subjects significantly [ 16 , 18 , 22 , 37 , 38 , 40 , 47 , 56 , 58 , 62 , 67 , 70 , 71 , 73 , 74 , 79 , 82 – 84 , 86 , 87 , 92 , 95 , 97 , 99 , 104 , 105 , 107 , 116 , 118 , 120 , 122 , 124 – 127 , 130 , 131 , 135 , 136 , 139 , 142 , 159 , 170 , 179 , 184 – 194 , 197 – 200 ]. By contrast, 15 studies showed females having higher asthma risk than males significantly [ 19 , 21 , 33 , 35 , 42 , 49 , 85 , 93 , 110 , 133 , 137 , 195 , 196 , 201 ]. Of these 75 studies, we removed 2 studies [ 125 , 126 ] from the subsequent meta-analysis due to their missing information in risk factor definition and inconsistency in disease definition.…”

“…The association between gender and asthma was reported in 75 studies [ 16 , 18 , 19 , 21 , 22 , 33 , 35 , 37 , 38 , 40 , 42 , 43 , 47 , 49 , 56 , 58 , 62 , 67 , 70 , 71 , 73 , 74 , 79 , 82 – 87 , 92 , 93 , 95 , 97 , 99 , 104 , 105 , 107 , 110 , 116 , 118 , 120 , 122 , 124 – 127 , 130 , 131 , 133 , 135 – 137 , 139 , 142 , 159 , 170 , 179 , 184 – 201 ]. Of these, 58 studies have observed male subjects having a higher asthma susceptibility as compared with that of the female subjects significantly [ 16 , 18 , 22 , 37 , 38 , 40 , 47 , 56 , 58 , 62 , 67 , 70 , 71 , 73 , 74 , …”

“…A total of 37 studies in Asia have investigated the association between BMI and asthma [ 19 , 38 , 42 – 45 , 47 , 49 , 61 , 125 , 135 , 153 , 162 , 167 , 185 , 186 , 196 , 200 , 201 , 204 , 213 , 217 – 232 ]. These studies have used different BMI cut-offs for defining overweight, obesity, and underweight status, while other studies have also analyzed BMI as a continuous variable (Table S 5 ).…”

“…These studies have used different BMI cut-offs for defining overweight, obesity, and underweight status, while other studies have also analyzed BMI as a continuous variable (Table S 5 ). In the random-effect meta-analysis for BMI as a continuous variable (8 studies) [ 38 , 43 , 49 , 135 , 153 , 201 , 204 , 230 ], the overall risk estimate for asthma was increased (pooled OR = 1.06, 95% CI : 1.03–1.08, I 2 = 84.7%, heterogeneity p value < 0.001; Fig. 2 and Fig.…”