Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis

Abstract

BackgroundIncreasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study’s aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett’s esophagus (BE) and esophageal carcinoma.MethodA case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside clinical endpoints of GERD, BE, and esophageal carcinoma. Multivariate analysis was utilized to identify factors that increase the propensity to develop BE and esophageal carcinoma. Statistical significance was p < 0.050.ResultsOne hundred sixty five thousand nine hundred twenty nine obese patients on PPI treatment were identified up until July 2017. Median follow-up time was 119.0 months (range 11.3–1397.9 months). In patients with GERD, the following were associated with increased BE risk: age ≥ 60 years (OR = 1.197; p = 0.039), male (OR = 2.209; p < 0.001), H2 antagonists (OR = 1.377; p < 0.001), D2 antagonists (OR = 1.241; p = 0.008), and hiatus hernias (OR = 6.772; p = 0.017). The following were associated with increased risk of esophageal carcinoma: age (OR = 2.831; p = 0.031), male sex (OR = 3.954; p = 0.003), and hiatus hernias (OR = 12.170; p < 0.001). Only D2 antagonists (OR = 2.588; p = 0.002) were associated with increased risk of developing esophageal carcinoma in BE patients.ConclusionsIn obese patients on PPI therapy for reflux, higher BMIs were not associated with increased risk of BE or esophageal carcinoma. Males, older patients, and those with hiatus hernias are at increased risk of developing BE and carcinoma. Failure of PPI monotherapy is predictive of future metaplasia and dysplasia.Electronic supplementary materialThe online version of this article (10.1007/s11695-018-3246-4) contains supplementary material, which is available to authorized users.

Chronic cough and obesity

“…However, during PPI treatment, BMI was not a significant independent predictor of heartburn resolution or EE healing [26]. When obese patients are treated with PPI therapy for reflux, no increased risk of BE or oesophageal carcinoma has been observed [27]. If a GERD-induced cough is suspected in clinical practice, PPIs should be tested [6].…”

Association between hiatal hernia and Barrett’s esophagus: an updated meta-analysis with trial sequential analysis

“…They were published between 1985 and 2022. Sixteen studies were performed in Asia, 19 – 34 16 in Europe, 35 – 50 14 in America, 51 – 64 and 1 in Oceania. 65 …”

Proton pump inhibitors in Iranian population: from clinical regimens to pharmacogenomics

“…In case of significant erosive esophagitis, PPI therapy is maintained even if it is asymptomatic (Badillo and Francis, 2014). Although, some recent studies demonstrated an increased risk of esophageal adeno carcinogenesis for patients taking PPIs especially for a long time (Cheung et al, 2018;Duan et al, 2009;Erridge et al, 2018;Kinoshita et al, 2018), not enough studies are performed on the side effects of long term consumption of PPIs on GERD in Iranian population.…”