Digestive Diseases and Sciences

, Volume 61, Issue 2, pp 507–516 | Cite as

Noninvasive Prediction of Erosive Esophagitis Using a Controlled Attenuation Parameter (CAP)-Based Risk Estimation Model

  • Hyunsoo Chung
  • Young Eun Chon
  • Seung Up KimEmail author
  • Sang Kil LeeEmail author
  • Kyu Sik Jung
  • Kwang-Hyub Han
  • Chae Yoon Chon
Original Article



Erosive esophagitis and fatty liver share obesity and visceral fat as common critical pathogenesis. However, the relationship between the amount of hepatic fat and the severity of erosive esophagitis was not well investigated, and there is no risk estimation model for erosive esophagitis.


To evaluate the relationship between the amount of hepatic fat and the severity of erosive esophagitis and then develop a risk estimation model for erosive esophagitis.


We enrolled 1045 consecutive participants (training cohort, n = 705; validation cohort, n = 340) who underwent esophagogastroduodenoscopy and CAP. The relationship between severity of fatty liver and erosive esophagitis was investigated, and independent predictors for erosive esophagitis that have been investigated through logistic regression analyses were used as components for establishing a risk estimation model.


The prevalence of erosive gastritis was 10.7 %, and the severity of erosive esophagitis was positively correlated with the degree of hepatic fatty accumulation (P < 0.05). A CAP-based risk estimation model for erosive esophagitis using CAP, Body mass index, and significant alcohol Drinking as constituent variables was established and was dubbed the CBD score (AUROC = 0.819, range 0–11). The high-risk group (CBD score ≥3) showed significantly higher risk of having erosive esophagitis than the low-risk group (CBD score <3) (24.1 vs. 2.7 %, respectively; P < 0.001). The diagnostic accuracy of CBD score was maintained in the validation cohort (AUROC = 0.848).


The severity of erosive esophagitis was positively correlated with the degree of hepatic fatty accumulation, and the CBD score might be a simple CAP-based risk model for predicting erosive esophagitis.


Erosive esophagitis Fatty liver Controlled attenuation parameter GERD 



Controlled attenuation parameter


Confidence interval


Gastroesophageal reflux disease


Nonalcoholic fatty liver disease




Transient elastography


Blood pressure


Body mass index


Liver stiffness


Interquartile range


Area under the receiver operating characteristic curve


Odds ratio



The authors are grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) and Kijun Song (Department of Biostatics, Yonsei University College of Medicine, Seoul, Korea) for their help with this journal. This study was supported by the Liver Cirrhosis Clinical Research Center, in part by a grant from the Korea Healthcare Technology R&D project, Ministry of Health and Welfare, Republic of Korea (No. HI10C2020). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contributions

Hyunsoo Chung and Young Eun Chon participated in patient management and data collection, contributed to the data acquisition, and were responsible for writing the paper and statistical analysis. Seung Up Kim and Sang Kil Lee conceptualized and designed the study, contributed to the data acquisition, and were responsible for writing the paper and statistical analysis. Kyu Sik Jung, Kwang-Hyub Han, and Chae Yoon participated in patient management and data collection. All authors reviewed the paper and approved the final version.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Hyunsoo Chung
    • 1
    • 2
  • Young Eun Chon
    • 1
    • 3
  • Seung Up Kim
    • 1
    • 2
    Email author
  • Sang Kil Lee
    • 1
    • 2
    Email author
  • Kyu Sik Jung
    • 1
  • Kwang-Hyub Han
    • 1
    • 2
  • Chae Yoon Chon
    • 4
  1. 1.Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  2. 2.Institute of GastroenterologyYonsei University College of MedicineSeoulSouth Korea
  3. 3.International Health Care CenterSeverance HospitalSeoulSouth Korea
  4. 4.Severance Checkup, Yonsei Health SystemYonsei UniversitySeoulSouth Korea

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