Differences in Several Factors in the Development of Erosive Esophagitis Among Patients at Various Stages of Metabolic Syndrome: A Cross-Sectional Study

Abstract

Background Erosive esophagitis (EE) is strongly associated with metabolic syndrome (MS), but is not always recognized in individuals with MS and the prevalence of EE in individuals with non-MS is not low. Aim To examine the differences in clinical factors associated with EE at various stages of MS, as well as the differences in metabolites between subjects with MS, with and without EE. Methods A total of 7,097 persons who underwent health checkups including esophagogastroduodenoscopy were analyzed. We examined the differences in clinical factors for EE among subjects with non-MS, pre-MS, and MS and compared metabolites between 34 subjects with MS, with and without EE. Results EE prevalence was significantly higher in the MS and pre-MS groups than in the non-MS group ( p < 0.001). EE severity was higher in the MS group than in the pre-MS and non-MS groups ( p < 0.001). In the non-MS group, there were significant differences between subjects with and without EE with respect to Helicobacter pylori ( H. pylori ) and smoking. In the pre-MS and MS groups, there were significant differences in H. pylori , hiatal hernia, and drinking in those with and without EE. The levels of glutamine, hypoxanthine, and lactic acid metabolites were significantly different between subjects with MS, with and without EE (all p < 0.05). Conclusion Although H. pylori and lifestyle factors such as smoking and drinking are important for EE, differences in these factors should be considered at various stages of MS. Additionally, several metabolites may be involved in the development of EE in MS.

Lifestyle Factors Associated With Erosive Esophagitis in Japanese Individuals With and Without Obesity Undergoing Health Checkups

“…Several studies have investigated the associated factors in relation to the severity of EE. 20 , 24 However, most of the EE cases in Japan are mild, and more than 80% of the EEs were Los Angeles classification A or B. 7 , 24 Therefore, we do not believe that our findings would be altered even if the severity of reflux esophagitis were to have been taken into account.…”

“… 20 , 24 However, most of the EE cases in Japan are mild, and more than 80% of the EEs were Los Angeles classification A or B. 7 , 24 Therefore, we do not believe that our findings would be altered even if the severity of reflux esophagitis were to have been taken into account. In addition, we focused on EE but not NERD.…”

“…Alcohol consumption is thought to be associated with an increase in gastric acid secretion and a decrease in LES pressure. 24 Another study also showed that excessive alcohol consumption (≥40 g) on drinking days was associated with the severity of EE in men. 26 Heavy drinking, but not light to moderate drinking, might be associated with EE.…”

“…A number of articles have reported that smoking is a risk factor for EE. 20 , 24 Smoking reduces LES pressure, which facilitates gastric acid reaching the esophagus. In addition, smoking reduces salivary bicarbonate secretion, which normally neutralizes the acidity of gastric contents.…”

“…In addition, smoking reduces salivary bicarbonate secretion, which normally neutralizes the acidity of gastric contents. 24 , 25 A large cohort study showed that smoking cessation was associated with an improvement in severe reflux symptoms compared to continued daily smoking. However, this has only been observed in normal weight individuals and not in overweight individuals.…”