Increased incidence of gastroesophageal reflux disease in patients with chronic hepatitis B virus infection

Abstract

Background Although chronic liver disease is associated with gastroesophageal reflux disease (GERD), the impact of chronic hepatitis B virus (HBV) infection on this association remains unclear. We thus aimed to evaluate the relationship between chronic HBV infection and GERD.Methods In this prospective population-based study, 1,001 adult subjects who underwent an upper gastrointestinal endoscopic examination in a health check-up and completed a gastroesophageal reflux questionnaire were consecutively enrolled. Endoscopic findings were classified according to the Los Angeles classification. Hepatitis B surface antigen was used as a marker of HBV infection. Univariate and multivariate approaches were used to evaluate the effects of chronic HBV infection on GERD.Results Chronic HBV infection was associated with heartburn sensation [odds ratio (OR) 1.27, 95% confidence interval 1.01-1.61, P = 0.037], and erosive esophagitis (adjusted OR 1.75, 1.03-2.97, P = 0.037). Although male gender is a risk factor of erosive esophagitis, further analyses stratified by gender and aspartate aminotransferase to platelet ratio index (APRI) showed that chronic HBV infection was associated with erosive esophagitis in female subjects (adjusted OR 2.70, 1.14-6.39, P = 0.024) and those with APRI of more than 0.3 (adjusted OR 3.94, 1.73-8.96, P = 0.001). Moreover, higher serum aspartate aminotransferase (AST) and triglyceride (TG) levels were risk factors of erosive esophagitis in patients with chronic HBV infection. Conclusions Our findings indicate a close association between chronic HBV infection and GERD, especially in female subjects and those with higher APRI levels. Moreover, HBV carriers with higher AST or TG levels have higher incidence of erosive esophagitis. The interactions between chronic HBV infection and GERD need further studies.

Nonalcoholic fatty liver disease vs. obesity on the risk of erosive oesophagitis

“…Fatty liver was found to be associated with a higher prevalence of EE in a report from South Korea, but the study did not exclude the potentially confounding effects of excessive alcohol consumption, hepatitis B and hepatitis C [10]. Excessive alcohol consumption, hepatitis B and hepatitis C may play a role in fatty liver, and excessive alcohol consumption and hepatitis B may be related to the risk of EE [6,[11][12][13][14]. We thus excluded the subjects with hepatitis B, hepatitis C and excessive alcohol consumption in the current study, and the results showed that NAFLD was associated with increased risk of EE.…”

“…and fatty liver [10,11]. Hepatitis B and hepatitis C may also play a role in fatty liver [12,13], while hepatitis B has been associated with EE [14]. Nonalcoholic fatty liver disease (NAFLD) is defined as a subgroup of fatty liver, which is not due to excessive alcohol consumption or other causes of steatosis [15,16].…”

“… found a higher prevalence of EE in patients with fatty liver after adjustment for metabolic syndrome and other variables, but they did not exclude patients with heavy alcohol consumption, hepatitis B or hepatitis C. Excessive alcohol drinking may confound the pure effect of fatty liver on EE, because it can result in both EE and fatty liver . Hepatitis B and hepatitis C may also play a role in fatty liver , while hepatitis B has been associated with EE . Nonalcoholic fatty liver disease (NAFLD) is defined as a subgroup of fatty liver, which is not due to excessive alcohol consumption or other causes of steatosis .…”

Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome

“…After excluding patients who received proton pump inhibitors, histamine-2 receptor antagonists, aspirin, or NSAIDs in the 6 months preceding the invitation, or had a history of any gastrointestinal surgery, liver cirrhosis, or malignancy, 2752 participants were consecutively invited to enter this study and received screening, and 2604 responded to the survey on GERD and IBS [16]. A GERD patient was defined as any individual who has a diagnosis of endoscopic LA grade ≥ A or identified by RDQ score of at least 3.…”

“…The RDQ is an instrument for the diagnosis of GERD that can be easily administered by primary care physicians in community settings and has been validated previously in Chinese populations [16,21]. It examines symptoms of heartburn, acid regurgitation, and dyspepsia, addressed using 12 questions on the frequency, severity, and duration of burning and pain behind the breastbone, acidic taste in the mouth, movement of materials upward from the stomach, and burning and pain in the upper stomach [22].…”