METABOLIC SYNDROME / CLINICAL RESEARCH
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The prevalence of reflux esophagitis (RE) is relatively high around the world. We investigated routine metabolic parameters for associations with RE prevalence and severity, creating a user-friendly RE prediction nomogram.

Material and methods:
We included 10,881 individuals who had upper gastrointestinal endoscopy at a hospital. We employed univariate and multivariate logistic regression for independent risk factors related to RE prevalence, and conducted ordinal logistic regression for independent prognostic factors of RE severity. Subsequently, a nomogram was constructed using multivariate logistic regression analysis, and its performance was assessed through the utilization of receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC) analysis.

Results:
In this study, 43.8% (4769 individuals) had confirmed RE. Multivariate analysis identified BMI, age, alcohol use, diabetes, Helicobacter pylori, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), albumin, uric acid (UA), fT3, and fT4 as independent RE risk factors (p < 0.05). The personalized nomogram used 17 factors to predict RE, with an AUC of 0.921 (95% CI: 0.916–0.926), specificity 84.02%, sensitivity 84.86%, and accuracy 84.39%, reflecting excellent discrimination. Calibration, decision, and CIC analyses affirmed the model’s high predictive accuracy and clinical utility. Additionally, ordinal logistic regression linked hypertension, diabetes, HDL-C, LDL-C, TG, and TC to RE severity.

Conclusions:
Our study highlights the association between the routine metabolic parameters and RE prevalence and severity. The nomogram may be of great value for the prediction of RE prevalence.

 
REFERENCES (44)
1.
Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal reflux disease: a review. JAMA 2020; 324: 2536-47.
 
2.
Diab N, Patel M, O’Byrne P, Satia I. Narrative review of the mechanisms and treatment of cough in asthma, cough variant asthma, and non-asthmatic eosinophilic bronchitis. Lung 2022; 200: 707-16.
 
3.
Mehta RS, Staller K, Chan AT. Review of gastroesophageal reflux disease. JAMA 2021; 325: 1472.
 
4.
Altorki NK, Oliveria S, Schrump DS. Epidemiology and molecular biology of Barrett’s adenocarcinoma. Semin Surg Oncol 1997; 13: 270-80.
 
5.
Cook MB, Coburn SB, Lam JR, et al. Cancer incidence and mortality risks in a large US Barrett’s oesophagus cohort. Gut 2018; 67: 418-529.
 
6.
Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut 2012; 61: 970-6.
 
7.
Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ 2020; 371: m3786.
 
8.
Ze EY, Kim BJ, Kang H, Kim JG. Abdominal visceral to subcutaneous adipose tissue ratio is associated with increased risk of erosive esophagitis. Dig Dis Sci 2017; 62: 1265-71.
 
9.
Sogabe M, Okahisa T, Kurihara T et al. Differences in several factors in the development of erosive esophagitis among patients at various stages of metabolic syndrome: a cross-sectional study. Diabetes Metab Syndr Obes 2021; 14: 1589-600.
 
10.
Chung SJ, Kim D, Park MJ, 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.
 
11.
Drahos J, Ricker W, Parsons R, Pfeiffer RM, Warren JL, Cook MB. Metabolic syndrome increases risk of Barrett esophagus in the absence of gastroesophageal reflux: an analysis of SEER-Medicare Data. J Clin Gastroenterol 2015; 49: 282-8.
 
12.
Kallel L, Bibani N, Fekih M, et al. Metabolic syndrome is associated with gastroesophageal reflux disease based on a 24-hour ambulatory pH monitoring. Dise Esophagus 2011; 24: 153-9.
 
13.
Kumari R, Kumar S, Kant R. An update on metabolic syndrome: metabolic risk markers and adipokines in the development of metabolic syndrome. Diabetes Metab Syndr 2019; 13: 2409-17.
 
14.
Mitrovic B, Gluvic ZM, Obradovic M, et al. Non-alcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: where do we stand today? Arch Med Sci 2023; 19: 884-94.
 
15.
Wu P, Ma L, Dai GX, et al. The association of metabolic syndrome with reflux esophagitis: a case-control study. Neurogastroenterol Motil 2011; 23: 989-94.
 
16.
Nomura M, Tashiro N, Watanabe T, et al. Association of symptoms of gastroesophageal reflux with metabolic syndrome parameters in patients with endocrine disease. ISRN Gastroenterology 2014; 2014: 863206.
 
17.
Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996; 111: 85-92.
 
18.
Zhang T, Tseng C, Zhang Y, et al. CXCL1 mediates obesity-associated adipose stromal cell trafficking and function in the tumour microenvironment. Nature Commun 2016; 7: 11674.
 
19.
Eusebi LH, Cirota GG, Zagari RM, Ford AC. Global prevalence of Barrett’s oesophagus and oesophageal cancer in individuals with gastro-oesophageal reflux: a systematic review and meta-analysis. Gut 2021; 70: 456-63.
 
20.
Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: a systematic review. J Neurogastroenterol Motil 2011; 17: 14-27.
 
21.
Mohammadi M, Ramezani Jolfaie N, Alipour R, Zarrati M. Is metabolic syndrome considered to be a risk factor for gastroesophageal reflux disease (non-erosive or erosive esophagitis)? A Systematic Review of the Evidence. Iran Red Crescent Medical J 2016; 18: e30363.
 
22.
Fukunaga S, Nakano D, Tsutsumi T, et al. Lean/normal-weight metabolic dysfunction-associated fatty liver disease is a risk factor for reflux esophagitis. Hepatol Res 2022; 52: 699-711.
 
23.
Chung TH, Lee J, Jeong ID, Lee KC. Effect of weight changes on the development of erosive esophagitis. Korean J Family Med 2020; 41: 14-9.
 
24.
Richter JE, Rubenstein JH. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology 2018; 154: 267-76.
 
25.
Piqué N, Ponce M, Garrigues V, et al. Prevalence of severe esophagitis in Spain. Results of the PRESS study (Prevalence and Risk factors for Esophagitis in Spain: a cross-sectional study). United European Gastroenterol J 2016; 4: 229-35.
 
26.
Pan J, Cen L, Chen W, Yu C, Li Y, Shen Z. Alcohol consumption and the risk of gastroesophageal reflux disease: a systematic review and meta-analysis. Alcohol Alcoholism 2019; 54: 62-9.
 
27.
Chourasia D, Misra A, Tripathi S, Krishnani N, Ghoshal UC. Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry. Indian J Gastroenterol 2011; 30: 12-21.
 
28.
Nam SY, Choi IJ, Ryu KH, et al. The effect of abdominal visceral fat, circulating inflammatory cytokines, and leptin levels on reflux esophagitis. J Neurogastroenterol Motil 2015; 21: 247-54.
 
29.
Matsuzaki J, Suzuki H, Kobayakawa M et al. Association of visceral fat area, smoking, and alcohol consumption with reflux esophagitis and barrett’s esophagus in Japan. PLoS One 2015; 10: e0133865.
 
30.
Kim YM, Kim Y, Kim JH, et al. Triglyceride-glucose index is associated with gastroesophageal reflux disease and erosive reflux disease: a health checkup cohort study. Sci Rep 2022; 12: 20959.
 
31.
Song HJ, Shim KN, Yoon SJ, et al: The prevalence and clinical characteristics of reflux esophagitis in koreans and its possible relation to metabolic syndrome. J Korean Med Sci 2009; 24: 197-202.
 
32.
Fu S, Xu M, Zhou H, Wang Y, Tan Y, Liu D. Metabolic syndrome is associated with higher rate of gastroesophageal reflux disease: a meta-analysis. Neurogastroenterol Motil 2022; 34: e14234.
 
33.
Bou Daher H, Sharara AI. Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: the burning questions. World J Gastroenterol 2019; 25: 4805-13.
 
34.
Loke SS, Yang KD, Chen KD, Chen JF. Erosive esophagitis associated with metabolic syndrome, impaired liver function, and dyslipidemia. World J Gastroenterol 2013; 19: 5883-8.
 
35.
Hirata A, Kishida K, Nakatsuji H, et al. High prevalence of gastroesophageal reflux symptoms in type 2 diabetics with hypoadiponectinemia and metabolic syndrome. Nutr Metab 2012; 9: 4.
 
36.
Rieder F, Biancani P, Harnett K, Yerian L, Falk GW. Inflammatory mediators in gastroesophageal reflux disease: impact on esophageal motility, fibrosis, and carcinogenesis. Am J Physiol Gastrointest Liver Physiol 2010; 298: G571-81.
 
37.
Oh C, Youn JK, Han JW, Kim HY, Jung SE. Analysis of growth, nutritional status and hospital visitation scores associated with reflux after nissen fundoplication in neurologically impaired children with gastroesophageal reflux. World J Surg 2018; 42: 1463-8.
 
38.
Wiersinga WM, Touber JL. The relation between gastrin, gastric acid and thyroid function disorders. Acta Endocrinol 1980; 95: 341-9.
 
39.
Engevik AC, Kaji I, Goldenring JR. The physiology of the gastric parietal cell. Physiol Rev 2020; 100: 573-602.
 
40.
Płaczkowska S, Pawlik-Sobecka L, Kokot I, Piwowar A. The association between serum uric acid and features of metabolic disturbances in young adults. Arch Med Sci 2021; 17: 1277-85.
 
41.
Kuwabara M, Borghi C, Cicero AFG, et al. Elevated serum uric acid increases risks for developing high LDL cholesterol and hypertriglyceridemia: a five-year cohort study in Japan. Int J Cardiol 2018; 261: 183-8.
 
42.
Liu XZ, Xu X, Zhu JQ, Zhao DB. Association between three non-insulin-based indexes of insulin resistance and hyperuricemia. Clin Rheumatol 2019; 38: 3227-33.
 
43.
You L, Liu A, Wuyun G, Wu H, Wang P. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb 2014; 21: 355-65.
 
44.
Ceriello A, De Cosmo S, Rossi MC, et al. Variability in HbA1c, blood pressure, lipid parameters and serum uric acid, and risk of development of chronic kidney disease in type 2 diabetes. Diabetes Obes Metab 2017; 19: 1570-8.
 
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ISSN:1734-1922
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