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Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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Ki Bae Bang1, Jung Ho Park2
Correspondence to: Correspondence to: Jung Ho Park
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
Tel: +82-2-2001-2059, Fax: +82-2-2001-8340, E-mail: jungho3.park@samsung.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2018;12(6):633-640. https://doi.org/10.5009/gnl18148
Published online October 10, 2018, Published date November 15, 2018
Copyright © Gut and Liver.
Obesity is a risk factor for gastroesophageal reflux disease (GERD), with several studies demonstrating positive associations between body mass index (BMI) and GERD symptoms. However, little is known about the effect of BMI changes on erosive esophagitis (EE). In this study, we investigated whether BMI reduction could resolve EE. A retrospective cohort study was performed to assess the natural course of EE according to changes in BMI. Participants undergoing health check-ups from 2006 to 2012 were enrolled, and 1,126 subjects with EE were included. The degree of esophagitis was measured by upper endoscopy and serially checked over a 5-year follow-up. Logistic regression and Cox proportional hazards models were used to investigate the association between BMI reduction and EE resolution. Substantial weight loss is associated with EE resolution. The adjusted odds ratio for EE resolution was 1.44 (95% confidence interval [CI], 1.09 to 1.92) among participants with a decrease in BMI compared to those with no decrease in BMI. The EE resolution rate was related to the degree of BMI reduction. The effect of weight loss on EE resolution was higher among subjects who lost more weight. Compared with subjects with no decrease in BMI, the hazard ratios for EE resolution were 1.09 (95% CI, 0.89 to 1.35), 1.31 (95% CI, 1.01 to 1.72) and 2.12 (95% CI, 1.44 to 3.12) in subjects with BMI reductions of ≤1, 1–2, and >2 kg/m2, respectively. EE resolution is associated with a decrease in BMI, and weight loss is potentially an effective GERD treatment.Background/Aims
Methods
Results
Conclusions
Keywords: Gastroesophageal reflux, Body mass index, Erosive esophagitis, Weight loss
Gut and Liver 2018; 12(6): 633-640
Published online November 15, 2018 https://doi.org/10.5009/gnl18148
Copyright © Gut and Liver.
Ki Bae Bang1, Jung Ho Park2
1Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea, 2Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to:Correspondence to: Jung Ho Park
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
Tel: +82-2-2001-2059, Fax: +82-2-2001-8340, E-mail: jungho3.park@samsung.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Obesity is a risk factor for gastroesophageal reflux disease (GERD), with several studies demonstrating positive associations between body mass index (BMI) and GERD symptoms. However, little is known about the effect of BMI changes on erosive esophagitis (EE). In this study, we investigated whether BMI reduction could resolve EE. A retrospective cohort study was performed to assess the natural course of EE according to changes in BMI. Participants undergoing health check-ups from 2006 to 2012 were enrolled, and 1,126 subjects with EE were included. The degree of esophagitis was measured by upper endoscopy and serially checked over a 5-year follow-up. Logistic regression and Cox proportional hazards models were used to investigate the association between BMI reduction and EE resolution. Substantial weight loss is associated with EE resolution. The adjusted odds ratio for EE resolution was 1.44 (95% confidence interval [CI], 1.09 to 1.92) among participants with a decrease in BMI compared to those with no decrease in BMI. The EE resolution rate was related to the degree of BMI reduction. The effect of weight loss on EE resolution was higher among subjects who lost more weight. Compared with subjects with no decrease in BMI, the hazard ratios for EE resolution were 1.09 (95% CI, 0.89 to 1.35), 1.31 (95% CI, 1.01 to 1.72) and 2.12 (95% CI, 1.44 to 3.12) in subjects with BMI reductions of ≤1, 1–2, and >2 kg/m2, respectively. EE resolution is associated with a decrease in BMI, and weight loss is potentially an effective GERD treatment.Background/Aims
Methods
Results
Conclusions
Keywords: Gastroesophageal reflux, Body mass index, Erosive esophagitis, Weight loss
Table 1 Characteristics of Subjects According to the Resolution of Erosive Esophagitis
| Characteristics | Overall (n=1,126) | Resolution of EE | p-value | |
|---|---|---|---|---|
| No resolution (n=481) | Resolution (n=645) | |||
| Age, yr | 41.02±7.63 | 41.14±7.71 | 40.86±7.52 | 0.54 |
| Male sex | 90.3 | 94.6 | 87.1 | <0.001 |
| BMI, kg/m2 | 24.70±2.77 | 24.54±2.77 | 24.92±2.77 | 0.021 |
| Obesity, BMI ≥25 kg/m2 | 42.6 | 45.3 | 40.6 | 0.128 |
| Subjects with reduced BMI | 50.5 | 46.6 | 53.5 | 0.022 |
| Waist circumference, cm | 86.62±8.83 | 85.97±9.26 | 87.66±7.99 | 0.010 |
| Smoking (current) | 44.7 | 49.6 | 41.0 | 0.005 |
| Hypertension | 17.6 | 17.5 | 17.7 | 0.947 |
| Alcohol, g/day | 14.38±15.2 | 13.85±15.02 | 15.08±15.42 | 0.182 |
| Hiatal hernia | 3.6 | 3.4 | 3.7 | 0.497 |
| Fatty liver on USG | 44.9 | 42.8 | 47.8 | 0.093 |
| Regular exercise | 19.4 | 21.1 | 17.1 | 0.094 |
| Education (≥college) | 81.5 | 82.4 | 80.4 | 0.457 |
| Metabolic syndrome | 14.7 | 16.2 | 13.6 | 0.235 |
Data are presented as the mean±SD or percentage.
EE, erosive esophagitis; BMI, body mass index; USG, ultrasonography.
Table 2 Resolution of Erosive Esophagitis According to BMI Reduction
| Variable | OR (95% CI) | ||
|---|---|---|---|
| Unadjusted | Adjusted 1 | Adjusted 2 | |
| Decrease in BMI | 1.32 (1.04–1.67) | 1.36 (1.06–1.73) | 1.44 (1.09–1.92) |
| Sex | - | 0.47 (0.28–0.78) | 0.49 (0.27–0.86) |
| Age | - | 1.00 (0.99–1.02) | 1.01 (0.99–1.03) |
| Smoking status | - | 0.82 (0.64–1.06) | 0.93 (0.69–1.26) |
| Alcohol intake | - | 1.00 (0.99–1.01) | 1.00 (0.99–1.01) |
| BMI | - | 0.97 (0.92–1.01) | 0.96 (0.90–1.02) |
| Education | - | - | 1.31 (0.90–1.91) |
| Regular exercise | - | - | 1.06 (0.72–1.55) |
| Fatty liver | - | - | 1.05 (0.76–1.45) |
| Metabolic syndrome | - | - | 0.72 (0.46–1.11) |
Adjusted 1 was adjusted for sex, age, smoking status, alcohol intake and body mass index (BMI). Adjusted 2 was adjusted for all variables in adjusted 1 plus education status, regular exercise, fatty liver, and metabolic syndrome.
OR, odds ratio; CI, confidence interval.
Table 3 Resolution of Erosive Esophagitis According to Obesity Status
| Variable | OR (95% CI) | ||
|---|---|---|---|
| BMI <25 kg/m2 (n=646) | BMI ≥25 kg/m2 (n=480) | Overall (n=1,126) | |
| Decrease in BMI | |||
| 0 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| ≤1 | 1.38 (0.91–2.10) | 0.99 (0.60–1.62) | 1.19 (0.87–1.63) |
| 1–2 | 1.65 (0.88–3.09) | 1.86 (1.01–3.44) | 1.76 (1.14–2.71) |
| >2 | 2.53 (0.63–10.22) | 2.89 (1.25–6.70) | 2.86 (1.41–5.81) |
| Sex | 0.42 (0.22–0.81) | 0.55 (0.14–2.14) | 0.44 (0.25–0.78) |
| Age | 1.02 (0.99–1.04) | 1.01 (0.97–1.04) | 1.01 (0.99–1.03) |
| Smoking status | 0.93 (0.61–1.40) | 0.95 (0.61–1.48) | 0.94 (0.69–1.27) |
| Alcohol intake | 1.00 (0.99–1.02) | 1.00 (0.99–1.02) | 1.00 (0.99–1.01) |
| Education | 1.39 (0.84–2.28) | 1.17 (0.64–2.15) | 1.30 (0.89–1.90) |
| Regular exercise | 0.94 (0.57–1.54) | 1.33 (0.71–2.47) | 1.06 (0.73–1.56) |
| Fatty liver | 0.99 (0.63–1.55) | 0.89 (0.56–1.42) | 0.93 (0.69–1.26) |
| Metabolic syndrome | 0.79 (0.30–2.09) | 0.66 (0.40–1.10) | 0.64 (0.42–0.98) |
OR, odds ratio; CI, confidence interval; BMI, body mass index.
Table 4 Resolution of Erosive Esophagitis According to Change in BMI
| Variable | HR (95% CI) | ||
|---|---|---|---|
| Unadjusted | Adjusted 1 | Adjusted 2 | |
| Decrease in BMI | |||
| 0 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| ≤1 | 1.10 (0.92–1.31) | 1.10 (0.92–1.32) | 1.09 (0.89–1.35) |
| 1–2 | 1.23 (0.98–1.54) | 1.23 (0.98–1.56) | 1.31 (1.01–1.72) |
| >2 | 1.81 (1.30–2.51) | 2.07 (1.48–2.91) | 2.12 (1.44–3.12) |
Adjusted 1 was adjusted for sex, age, body mass index (BMI), smoking status, and alcohol intake. Adjusted 2 was adjusted for all variables in adjusted 1 plus fatty liver, education status, regular exercise, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homeostatic model assessment for insulin resistance.
HR, hazard ratio; CI, confidence interval.
pISSN 1976-2283
eISSN 2005-1212
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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