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Association between metabolic syndrome and prevalence of gastroesophageal reflux disease in a health screening facility in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

Abdominal fat accumulation, which induces high intra-abdominal pressure that causes increase in the gastroesophageal pressure gradient and hiatal hernia, as well as obesity, has been shown to increase the prevalence of gastroesophageal reflux disease (GERD). This study was performed to clarify the association between metabolic syndrome and the prevalence of GERD.

Methods

The study subjects were an adult population who visited a medical center for annual medical check-ups from April 2010 to March 2011. GERD was diagnosed by the presence of endoscopically proven reflux esophagitis, GERD symptoms (QUEST score ≥6), or current medical therapy for GERD. The presence of metabolic or pre-metabolic syndrome was diagnosed based on the Japanese criteria for metabolic syndrome.

Results

Six hundred four (16.0 %) of 3775 study subjects were positively diagnosed with GERD, with the number of those with metabolic and pre-metabolic syndrome being 477 (12.6 %) and 384 (10.2 %), respectively. Multiple logistic regression analysis showed that male gender, presence of hiatal hernia, and metabolic or pre-metabolic syndrome, as well as absence of gastric mucosal atrophy, were significant predictive factors for the prevalence of GERD, as were visceral fat accumulation and untreated dyslipidemia. Untreated hypertension and untreated hyperglycemia were also considered to be positive risk factors. Subjects undergoing treatment for hypertension showed an increased risk of GERD, while those undergoing treatment for dyslipidemia and diabetes mellitus showed a decreased risk.

Conclusion

Metabolic syndrome is a reliable predictive factor for the prevalence of GERD, and medical therapy for metabolic syndrome may modify the risk of GERD occurrence.

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References

  1. Dodds WJ, Hogan WJ, Helm JF, Dent J. Pathogenesis of reflux esophagitis. Gastroenterology. 1981;81:376–94.

    PubMed  CAS  Google Scholar 

  2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.

    Article  PubMed  Google Scholar 

  3. Kennedy T, Jones R. The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther. 2000;14:1589–94.

    Article  PubMed  CAS  Google Scholar 

  4. Haque M, Wyeth JW, Stace NH, Talley NJ, Green R. Prevalence, severity and associated features of gastro-oesophageal reflux and dyspepsia: a population-based study. N Z Med J. 2000;113:178–81.

    PubMed  CAS  Google Scholar 

  5. Furukawa N, Iwakiri R, Koyama T, Okamoto K, Yoshida T, Kashiwagi Y, et al. Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol. 1999;3:441–4.

    Article  Google Scholar 

  6. Amano K, Adachi K, Katsube T, Watanabe M, Kinoshita Y. Role of hiatus hernia and gastric mucosal atrophy in the development of reflux esophagitis in the elderly. J Gastroenterol Hepatol. 2001;16:132–6.

    Article  PubMed  CAS  Google Scholar 

  7. Shimazu T, Matsui T, Furukawa K, Oshige K, Mitsuyasu T, Kiyomizu A, et al. A prospective study of the prevalence of gastroesophageal reflux disease and confounding factors. J Gastroenterol. 2005;40:866–72.

    Article  PubMed  Google Scholar 

  8. Mishima I, Adachi K, Arima N, Amano K, Takashima T, Moritani M, et al. Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese. Scand J Gastroenterol. 2005;40:1005–9.

    Article  PubMed  Google Scholar 

  9. Fujimoto K. Prevalence and epidemiology of gastro-oesophageal reflux disease in Japan. Aliment Pharmacol Ther. 2004;20(Suppl 8):5–8.

    Article  PubMed  Google Scholar 

  10. Wu JC. Gastroesophageal reflux disease: an Asian perspective. J Gastroenterol Hepatol. 2008;23:1785–93.

    Article  PubMed  Google Scholar 

  11. Fujiwara Y, Arakawa T. Epidemiology and clinical characteristics of GERD in the Japanese population. J Gastroenterol. 2009;44:518–34.

    Article  PubMed  Google Scholar 

  12. Kinoshita Y, Adachi K, Hongo M, Haruma K. Systematic review of the epidemiology of gastroesophageal reflux disease in Japan. J Gastroenterol. 2011;46:1092–103.

    Article  PubMed  Google Scholar 

  13. Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.

    Article  PubMed  CAS  Google Scholar 

  14. Wajed SA, Streets CG, Bremner CG, DeMeester TR. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–8.

    Article  PubMed  CAS  Google Scholar 

  15. Hong D, Khajanchee YS, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL. Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg. 2004;14:744–9.

    Article  PubMed  Google Scholar 

  16. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130:639–49.

    Article  PubMed  Google Scholar 

  17. de Vries DR, van Herwaarden MA, Smout AJ, Samsom M. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure. Am J Gastroenterol. 2008;103:1349–54.

    Article  PubMed  Google Scholar 

  18. Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey. Ann Epidemiol. 1999;9:424–35.

    Article  PubMed  CAS  Google Scholar 

  19. Fisher BL, Pennathur A, Mutnick JL, Little AG. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290–4.

    Article  PubMed  CAS  Google Scholar 

  20. Murray L, Johnston B, Lane A, Harvey I, Donovan J, Nair P, et al. Relationship between body mass and gastro-oesophageal reflux symptoms: the Bristol Helicobacter Project. Int J Epidemiol. 2003;32:645–50.

    Article  PubMed  Google Scholar 

  21. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR 3rd, Rodriguez-Artalejo F. Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther. 2004;19:95–105.

    Article  PubMed  CAS  Google Scholar 

  22. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.

    Article  PubMed  Google Scholar 

  23. Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:2619–28.

    Article  PubMed  Google Scholar 

  24. Watanabe S, Hojo M, Nagahara A. Metabolic syndrome and gastrointestinal diseases. J Gastroenterol. 2007;42:267–74.

    Article  PubMed  Google Scholar 

  25. Iwakiri R, Fujimoto K. Importance of vertebral fracture and body mass index in the pathogenesis of gastroesophageal reflux disease. Intern Med. 2008;47:1551–3.

    Article  PubMed  Google Scholar 

  26. Sakaguchi M, Oka H, Hashimoto T, Asakuma Y, Takao M, Gon G, et al. Obesity as a risk factor for GERD in Japan. J Gastroenterol. 2008;43:57–62.

    Article  PubMed  Google Scholar 

  27. Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Di Biase AR, et al. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol. 2009;15:1690–701.

    Article  PubMed  Google Scholar 

  28. Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC, et al. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case–control study of 7078 Koreans undergoing health check-ups. Gut. 2008;57:1360–5.

    Article  PubMed  CAS  Google Scholar 

  29. The Examination Committee of Criteria for ‘Metabolic Syndrome’ in Japan. Criteria for ‘metabolic syndrome’ in Japan. J Jpn Soc Int Med. 2005;94:794–809. (in Japanese).

    Article  Google Scholar 

  30. Miyawaki T, Hirata M, Moriyama K, Sasaki Y, Aono H, Saito N, et al. Metabolic syndrome in Japanese diagnosed with visceral fat measurement by computed tomography. Proc Jpn Acad. 2005;81:471–9.

    Article  Google Scholar 

  31. Moki F, Kusano M, Mizuide M, Shimoyama Y, Kawamura O, Takagi H, et al. Association between reflux oesophagitis and features of the metabolic syndrome in Japan. Aliment Pharmacol Ther. 2007;26:1069–75.

    Article  PubMed  CAS  Google Scholar 

  32. Kim J, Tanabe K, Yokoyama N, Zempo H, Kuno S. Association between physical activity and metabolic syndrome in middle-aged Japanese: a cross-sectional study. BMC Public Health. 2011;11:624.

    Article  PubMed  Google Scholar 

  33. Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al. The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol. 1998;33:1023–9.

    Article  PubMed  CAS  Google Scholar 

  34. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  PubMed  CAS  Google Scholar 

  35. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;3:87–97.

    Article  Google Scholar 

  36. Miki K, Ichinose M, Shimazu A. Serum pepsinogen as a screening test of extensive chronic gastritis. Gastroenterol Jpn. 1987;22:133–41.

    PubMed  CAS  Google Scholar 

  37. Meining A, Classen M. The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2000;95:2692–7.

    Article  PubMed  CAS  Google Scholar 

  38. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.

    Article  PubMed  Google Scholar 

  39. El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54:11–7.

    Article  PubMed  CAS  Google Scholar 

  40. Becker DJ, Sinclair J, Castell DO, Wu WC. A comparison of high and low fat meals on postprandial esophageal acid exposure. Am J Gastroenterol. 1989;84:782–6.

    PubMed  CAS  Google Scholar 

  41. Iwakiri K, Kobayashi M, Kotoyori M, Yamada H, Sugiura T, Nakagawa Y. Relationship between postprandial esophageal acid exposure and meal volume and fat content. Dig Dis Sci. 1996;41:926–30.

    Article  PubMed  CAS  Google Scholar 

  42. Clavé P, González A, Moreno A, López R, Farré A, Cussó X, et al. Endogenous cholecystokinin enhances postprandial gastroesophageal reflux in humans through extrasphincteric receptors. Gastroenterology. 1998;115:597–604.

    Article  PubMed  Google Scholar 

  43. Ledeboer M, Masclee AA, Biemond I, Lamers CB. Effect of medium- and long-chain triglycerides on lower esophageal sphincter pressure: role of CCK. Am J Physiol. 1998;274(6 Pt 1):G1160–5.

    PubMed  CAS  Google Scholar 

  44. Trudgill NJ, Riley SA. Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol. 2001;96:2569–74.

    Article  PubMed  CAS  Google Scholar 

  45. Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5:439–44.

    Article  PubMed  Google Scholar 

  46. Kinoshita Y, Kawanami C, Kishi K, Nakata H, Seino Y, Chiba T. Helicobacter pylori independent chronological change in gastric acid secretion in the Japanese. Gut. 1997;41:452–8.

    Article  PubMed  CAS  Google Scholar 

  47. Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol. 2007;41:131–7.

    Article  PubMed  Google Scholar 

  48. Barlow WJ, Orlando RC. The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis. Gastroenterology. 2005;128:771–8.

    Article  PubMed  Google Scholar 

  49. Nagahara A, Miwa H, Minoo T, Hojo M, Kawabe M, Osada T, et al. Increased esophageal sensitivity to acid and saline in patients with nonerosive gastro-esophageal reflux disease. J Clin Gastroenterol. 2006;40:891–5.

    Article  PubMed  CAS  Google Scholar 

  50. Rodriguez-Stanley S, Robinson M, Earnest DL, Greenwood-Van Meerveld B, Miner PB Jr. Esophageal hypersensitivity may be a major cause of heartburn. Am J Gastroenterol. 1999;94:628–31.

    Article  PubMed  CAS  Google Scholar 

  51. Meyer JH, Lembo A, Elashoff JD, Fass R, Mayer EA. Duodenal fat intensifies the perception of heartburn. Gut. 2001;49:624–8.

    Article  PubMed  CAS  Google Scholar 

  52. Shapiro M, Green C, Bautista M, Dekel R, Risner-Adler S, Whitacre R, et al. Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;25:93–101.

    Article  PubMed  CAS  Google Scholar 

  53. Furuta K, Adachi K, Arima N, Yagi J, Tanaka S, Miyaoka Y, et al. Study of arteriosclerosis in patients with hiatal hernia and reflux esophagitis. J Gastroenterol Hepatol. 2007;22:1732–6.

    Article  PubMed  Google Scholar 

  54. Hongo M, Traube M, McAllister RG Jr, McCallum RW. Effects of nifedipine on esophageal motor function in humans: correlation with plasma nifedipine concentration. Gastroenterology. 1984;86:8–12.

    PubMed  CAS  Google Scholar 

  55. Ishikawa H, Iwakiri K, Sugiura T, Kobayashi M. Effect of nifedipine administration (10 mg) on esophageal acid exposure time. J Gastroenterol. 2000;35:43–6.

    Article  PubMed  CAS  Google Scholar 

  56. Yoshida K, Furuta K, Adachi K, Ohara S, Morita T, Tanimura T, et al. Effects of anti-hypertensive drugs on esophageal body contraction. World J Gastroenterol. 2010;16:987–91.

    Article  PubMed  CAS  Google Scholar 

  57. Miwa H, Hongo M, Kusano M. Combination of angiotensin II receptor blockers promotes proton pump inhibitor-based healing of reflux esophagitis. J Gastroenterol. 2012;47:249–55.

    Article  PubMed  CAS  Google Scholar 

  58. Newrick PG, Bowman C, Green D, O’Brien IA, Porter SR, Scully C, et al. Parotid salivary secretion in diabetic autonomic neuropathy. J Diabet Complicat. 1991;5:35–7.

    Article  CAS  Google Scholar 

  59. Koch KL. Diabetic gastropathy: gastric neuromuscular dysfunction in diabetes mellitus: a review of symptoms, pathophysiology, and treatment. Dig Dis Sci. 1999;44:1061–75.

    Article  PubMed  CAS  Google Scholar 

  60. Lluch I, Ascaso JF, Mora F, Minguez M, Peña A, Hernandez A, et al. Gastroesophageal reflux in diabetes mellitus. Am J Gastroenterol. 1999;94:919–24.

    Article  PubMed  CAS  Google Scholar 

  61. Nishida T, Tsuji S, Tsujii M, Arimitsu S, Sato T, Haruna Y, et al. Gastroesophageal reflux disease related to diabetes: analysis of 241 cases with type 2 diabetes mellitus. J Gastroenterol Hepatol. 2004;19:258–65.

    Article  PubMed  Google Scholar 

  62. Kase H, Hattori Y, Sato N, Banba N, Kasai K. Symptoms of gastroesophageal reflux in diabetes patients. Diabetes Res Clin Pract. 2008;79:e6–7.

    Article  PubMed  CAS  Google Scholar 

  63. Horikawa A, Ishii-Nozawa R, Ohguro M, Takagi S, Ohtuji M, Yamada M, et al. Prevalence of GORD (gastro-oesophageal reflux disease) in Type 2 diabetes and a comparison of clinical profiles between diabetic patients with and without GORD. Diabet Med. 2009;26:228–33.

    Article  PubMed  CAS  Google Scholar 

  64. Hirata A, Kishida K, Nakatsuji H, Inoue K, Hiuge-Shimizu A, Funahashi T, et al. High prevalence of gastroesophageal reflux symptoms in type 2 diabetics with hypoadiponectinemia and metabolic syndrome. Nutr Metab (Lond). 2012;9:4.

    Article  CAS  Google Scholar 

  65. Niemelä S, Karttunen T, Korhonen T, Läärä E, Karttunen R, Ikäheimo M, et al. Could Helicobacter pylori infection increase the risk of coronary heart disease by modifying serum lipid concentrations? Heart. 1996;75:573–5.

    Article  PubMed  Google Scholar 

  66. Laurila A, Bloigu A, Näyhä S, Hassi J, Leinonen M, Saikku P. Association of Helicobacter pylori infection with elevated serum lipids. Atherosclerosis. 1999;142:207–10.

    Article  PubMed  CAS  Google Scholar 

  67. Takashima T, Adachi K, Kawamura A, Yuki M, Fujishiro H, Rumi MAK, et al. Cardiovascular risk factors in subjects with Helicobacter pylori infection. Helicobacter. 2002;7:86–90.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was partially supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology-Japan (No. 22590681).

Conflict of interest

None of the authors have any conflicts of interest associated with this study.

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Authors and Affiliations

  1. Division of Internal Medicine, National Hospital Organization Hamada Medical Center, Hamada, Japan

    Masatoshi Niigaki & Kazuya Hirakawa

  2. Department of Clinical Nursing, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan

    Kyoichi Adachi

  3. Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan

    Kenji Furuta & Yoshikazu Kinoshita

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  1. Masatoshi Niigaki
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  2. Kyoichi Adachi
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  3. Kazuya Hirakawa
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  5. Yoshikazu Kinoshita
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Correspondence to Kyoichi Adachi.

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Niigaki, M., Adachi, K., Hirakawa, K. et al. Association between metabolic syndrome and prevalence of gastroesophageal reflux disease in a health screening facility in Japan. J Gastroenterol 48, 463–472 (2013). https://doi.org/10.1007/s00535-012-0671-3

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  • DOI: https://doi.org/10.1007/s00535-012-0671-3

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