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

Digestive Diseases and Sciences volume 61, pages 507–516 (2016)Cite this article

Abstract

Background

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.

Aim

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.

Methods

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.

Results

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).

Conclusion

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.

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Abbreviations

CAP:

Controlled attenuation parameter

CI:

Confidence interval

GERD:

Gastroesophageal reflux disease

NAFLD:

Nonalcoholic fatty liver disease

EGD:

Esophagogastroduodenoscopy

TE:

Transient elastography

BP:

Blood pressure

BMI:

Body mass index

LS:

Liver stiffness

IQR:

Interquartile range

AUROC:

Area under the receiver operating characteristic curve

OR:

Odds ratio

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Acknowledgments

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.

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    Affiliations

    1. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

      Hyunsoo Chung, Young Eun Chon, Seung Up Kim, Sang Kil Lee, Kyu Sik Jung & Kwang-Hyub Han

    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea

      Hyunsoo Chung, Seung Up Kim, Sang Kil Lee & Kwang-Hyub Han

    3. International Health Care Center, Severance Hospital, Seoul, South Korea

      Young Eun Chon

    4. Severance Checkup, Yonsei Health System, Yonsei University, Seoul, South Korea

      Chae Yoon Chon

    Authors
    1. Hyunsoo Chung
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    2. Young Eun Chon
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    Correspondence to Seung Up Kim or Sang Kil Lee.

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    Additional information

    Hyunsoo Chung and Young Eun Chon have contributed equally to this work.

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    Cite this article

    Chung, H., Chon, Y.E., Kim, S.U. et al. Noninvasive Prediction of Erosive Esophagitis Using a Controlled Attenuation Parameter (CAP)-Based Risk Estimation Model. Dig Dis Sci 61, 507–516 (2016). https://doi.org/10.1007/s10620-015-3902-7

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    • DOI: https://doi.org/10.1007/s10620-015-3902-7

    Keywords

    • Erosive esophagitis
    • Fatty liver
    • Controlled attenuation parameter
    • GERD