Journal of Gastroenterology

, Volume 49, Issue 7, pp 1163–1174 | Cite as

The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease

  • Hiroyoshi Taketani
  • Yoshio SumidaEmail author
  • Saiyu Tanaka
  • Kento Imajo
  • Masato Yoneda
  • Hideyuki Hyogo
  • Masafumi Ono
  • Hideki Fujii
  • Yuichiro Eguchi
  • Kazuyuki Kanemasa
  • Kazuaki Chayama
  • Yoshito Itoh
  • Toshikazu Yoshikawa
  • Toshiji Saibara
  • Kazuma Fujimoto
  • Atsushi Nakajima
  • Japan Study Group of NAFLD (JSG-NAFLD)



It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated.


This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks.


Of the 123 patients, 76 (62 %) were female and 87 (71 %) were obese, with 34 (28 %) having AIS scores ≥ 6 and 31 (25 %) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33 %) had NAFL and 83 (67 %) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores.


Nearly 30 % of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.


GERD Insomnia Nonalcoholic fatty liver disease Proton-pump inhibitor 



Body mass index


Gastro-esophageal reflux disease


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Conflict of interest

Yuichiro Eguchi received a research grant from Bristol-Myers Squibb. Yoshito Itoh received commercial research funds from Dainippon Sumitomo Pharma Co., Ltd.


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Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Hiroyoshi Taketani
    • 1
  • Yoshio Sumida
    • 2
    Email author
  • Saiyu Tanaka
    • 1
  • Kento Imajo
    • 3
  • Masato Yoneda
    • 3
  • Hideyuki Hyogo
    • 4
  • Masafumi Ono
    • 5
  • Hideki Fujii
    • 6
  • Yuichiro Eguchi
    • 7
  • Kazuyuki Kanemasa
    • 1
  • Kazuaki Chayama
    • 4
  • Yoshito Itoh
    • 2
  • Toshikazu Yoshikawa
    • 2
  • Toshiji Saibara
    • 5
  • Kazuma Fujimoto
    • 7
  • Atsushi Nakajima
    • 3
  • Japan Study Group of NAFLD (JSG-NAFLD)
  1. 1.Center for Digestive and Liver DiseasesNara City HospitalNaraJapan
  2. 2.Department of Gastroenterology and HepatologyKyoto Prefectural University of MedicineKyotoJapan
  3. 3.Division of GastroenterologyYokohama City University Graduate School of MedicineYokohamaJapan
  4. 4.Department of Medicine and Molecular Science, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  5. 5.Department of Gastroenterology and HepatologyKochi Medical SchoolKochiJapan
  6. 6.Department of Hepatology, Graduate School of MedicineOsaka City UniversityOsakaJapan
  7. 7.Department of Internal Medicine, Saga Medical SchoolSaga UniversitySagaJapan

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