Visceral obesity and the risk of Barrett's esophagus in Japanese patients with non-alcoholic fatty liver disease

Abstract

BackgroundThe association between obesity and the risk of Barrett's esophagus (BE) is unclear. Furthermore, the association between visceral obesity and the risk of BE is entirely unknown.MethodsWe conducted a retrospective study in 163 patients with non-alcoholic fatty liver disease (NAFLD) who underwent both endoscopy and abdominal CT at an interval of less than a year at our institution. BE was endoscopically diagnosed based on the Prague C & M Criteria. The surface areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated from CT images at the level of the umbilicus. The correlations between the BMI, VAT, and SAT and the risk of BE were examined by univariate and multivariate analyses.ResultsSixty-nine of the 163 study participants (42.3%) were diagnosed to have endoscopic BE, which was classified as short-segment BE (SSBE) in almost all of the cases. There were no significant differences in the age or gender distribution between the groups with and without BE. According to the results of the univariate analysis, VAT was significantly associated with the risk of BE; the BMI tended to be higher in the group with BE than in the group without BE, but this relation did not reach statistical significance. VAT was independently associated with the risk of BE even after adjustment for the BMI.ConclusionIn Japanese patients with NAFLD, obesity tended to be associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal visceral adiposity.

Visceral Obesity and the Risk of Barrett’s Esophagus

“…There has been recent interest in the possible role of abdominal obesity in the development of GERD-related disorders [11,16,17,18]. Recent studies have shown abdominal obesity, as defined by the waist circumference (WC) and waist-to-hip ratio (WHR), to be a risk factor for BE independent of the BMI, with the association between BMI and BE being no longer observed after adjustment for the WC and WHR [16,17].…”

The Symptoms of Gastroesophageal Reflux Disease Correlate with High Body Mass Index, the Aspartate Aminotransferase/Alanine Aminotransferase Ratio and Insulin Resistance in Japanese Patients with Non-alcoholic Fatty Liver Disease

“…Our previous study suggested that the NAFLD status was positively related to insulin resistance caused by visceral fat accumulation (14), and the inflammatory changes induced by visceral fat accumulation may induce adipocytokine dysregulation (25). Adipocytokine dysregulation, especially reduced secretion of adiponectin, could induce lower sphincter tone, leading to the exacerbation GERD symptoms (10,25). In the present study, there was a weak association between insulin resistance and GERD symptoms measured by the FSSG, which warrants further examination.…”

“…Several studies suggested the association between symptoms of GERD and insulin resistance (10,14,25). Our previous study suggested that the NAFLD status was positively related to insulin resistance caused by visceral fat accumulation (14), and the inflammatory changes induced by visceral fat accumulation may induce adipocytokine dysregulation (25).…”

“…Several hypotheses have been proposed to explain this relationship, including i) increased intra-abdominal and intra-gastric pressure due to abdominal obesity, ii) the formation of an esophageal hiatal hernia, and iii) the intake of large amounts of foods and a high-fat diet, which increase the frequency of transient lower esophageal sphincter relaxation (TLESR). In contrast, the association between obesity and symptoms of GERD in Japanese patients remains unclear (5)(6)(7)(8)(9), although several studies in Japan have reported that visceral obesity was closely related to endoscopic reflux esophagitis, including Barrett's esophagus in patients with non-alcoholic fatty liver disease (NAFLD) (10), and metabolic syndrome was a risk factor for endoscopic reflux esophagitis (11).…”

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

“…However, there has been little study of the correlation between obesity and BE in Japan. Akiyama et al [101] reported a retrospective study on the positive association between VAT and BE in Japanese patients with non-alcoholic fatty liver disease, but the strength of the risk of BE was very weak (OR 1.0074, 95 % CI 1.0001-1.0147, p = 0.0472).…”