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Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications.

Abstract

BACKGROUND

The association of body mass index and gastroesophageal reflux disease (GERD), including its complications (esophagitis, Barrett esophagus, and esophageal adenocarcinoma), is unclear.

PURPOSE

To conduct a systematic review and meta-analysis to estimate the magnitude and determinants of an association between obesity and GERD symptoms, erosive esophagitis, Barrett esophagus, and adenocarcinoma of the esophagus and of the gastric cardia.

DATA SOURCES

MEDLINE search between 1966 and October 2004 for published full studies.

STUDY SELECTION

Studies that provided risk estimates and met criteria on defining exposure and reporting outcomes and sample size.

DATA EXTRACTION

Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were pooled by using a random-effects model.

DATA SYNTHESIS

Nine studies examined the association of body mass index (BMI) with GERD symptoms. Six of these studies found statistically significant associations. Six of 7 studies found significant associations of BMI with erosive esophagitis, 6 of 7 found significant associations with esophageal adenocarcinoma, and 4 of 6 found significant associations with gastric cardia adenocarcinoma. In data from 8 studies, there was a trend toward a dose-response relationship with an increase in the pooled adjusted odds ratios for GERD symptoms of 1.43 (95% CI, 1.158 to 1.774) for BMI of 25 kg/m2 to 30 kg/m2 and 1.94 (CI, 1.468 to 2.566) for BMI greater than 30 kg/m2. Similarly, the pooled adjusted odds ratios for esophageal adenocarcinoma for BMI of 25 kg/m2 to 30 kg/m2 and BMI greater than 30 kg/m2 were 1.52 (CI, 1.147 to 2.009) and 2.78 (CI, 1.850 to 4.164), respectively.

LIMITATIONS

Heterogeneity in the findings was present, although it was mostly in the magnitude of statistically significant positive associations. No studies in this review examined the association between Barrett esophagus and obesity.

CONCLUSION

Obesity is associated with a statistically significant increase in the risk for GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas 77030, USA.

    ,

    Source

    Annals of internal medicine 143:3 2005 Aug 02 pg 199-211

    MeSH

    Adenocarcinoma
    Barrett Esophagus
    Body Mass Index
    Cardia
    Esophageal Neoplasms
    Esophagitis
    Gastroesophageal Reflux
    Humans
    Obesity
    Odds Ratio
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, U.S. Gov't, Non-P.H.S.
    Systematic Review

    Language

    eng

    PubMed ID

    16061918

    Citation

    Hampel, Howard, et al. "Meta-analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications." Annals of Internal Medicine, vol. 143, no. 3, 2005, pp. 199-211.
    Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143(3):199-211.
    Hampel, H., Abraham, N. S., & El-Serag, H. B. (2005). Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Annals of Internal Medicine, 143(3), pp. 199-211.
    Hampel H, Abraham NS, El-Serag HB. Meta-analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications. Ann Intern Med. 2005 Aug 2;143(3):199-211. PubMed PMID: 16061918.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. AU - Hampel,Howard, AU - Abraham,Neena S, AU - El-Serag,Hashem B, PY - 2005/8/3/pubmed PY - 2005/8/9/medline PY - 2005/8/3/entrez SP - 199 EP - 211 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 143 IS - 3 N2 - BACKGROUND: The association of body mass index and gastroesophageal reflux disease (GERD), including its complications (esophagitis, Barrett esophagus, and esophageal adenocarcinoma), is unclear. PURPOSE: To conduct a systematic review and meta-analysis to estimate the magnitude and determinants of an association between obesity and GERD symptoms, erosive esophagitis, Barrett esophagus, and adenocarcinoma of the esophagus and of the gastric cardia. DATA SOURCES: MEDLINE search between 1966 and October 2004 for published full studies. STUDY SELECTION: Studies that provided risk estimates and met criteria on defining exposure and reporting outcomes and sample size. DATA EXTRACTION: Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were pooled by using a random-effects model. DATA SYNTHESIS: Nine studies examined the association of body mass index (BMI) with GERD symptoms. Six of these studies found statistically significant associations. Six of 7 studies found significant associations of BMI with erosive esophagitis, 6 of 7 found significant associations with esophageal adenocarcinoma, and 4 of 6 found significant associations with gastric cardia adenocarcinoma. In data from 8 studies, there was a trend toward a dose-response relationship with an increase in the pooled adjusted odds ratios for GERD symptoms of 1.43 (95% CI, 1.158 to 1.774) for BMI of 25 kg/m2 to 30 kg/m2 and 1.94 (CI, 1.468 to 2.566) for BMI greater than 30 kg/m2. Similarly, the pooled adjusted odds ratios for esophageal adenocarcinoma for BMI of 25 kg/m2 to 30 kg/m2 and BMI greater than 30 kg/m2 were 1.52 (CI, 1.147 to 2.009) and 2.78 (CI, 1.850 to 4.164), respectively. LIMITATIONS: Heterogeneity in the findings was present, although it was mostly in the magnitude of statistically significant positive associations. No studies in this review examined the association between Barrett esophagus and obesity. CONCLUSION: Obesity is associated with a statistically significant increase in the risk for GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/16061918/full_citation L2 - https://www.annals.org/article.aspx?volume=143&issue=3&page=199 DB - PRIME DP - Unbound Medicine ER -