Metabolic syndrome is associated with erosive esophagitis

Table 1 Comparisons between participants with and without erosive esophagitis (n = 5037)

	With erosive esophagitis (n = 1679)	Without erosive esophagitis (n = 3358)	P
Age (yr, mean ± SD)	45.2 ± 9.3	45.2 ± 9.7	0.873
Gender (M/F, %)	86/14	59/41	< 0.001
BMI (kg/m2)	24.8 ± 2.9	23.5 ± 3.0	< 0.001
Waist circumference (cm)	86.8 ± 8.7	81.5 ± 9.8	< 0.001
Current smoking	724 (43%)	786 (23%)	< 0.001
Alcohol use (≥ 3-4/wk)	360 (21%)	387 (12%)	< 0.001
Metabolic syndrome	352 (21%)	433 (13%)	< 0.001
Hiatal hernia	38 (2.2%)	24 (0.7%)	< 0.001
Reflux symptoms1	194 (12%)	265 (8.0%)	< 0.001
Systolic BP (mmHg)	118.3 ± 12.7	114.8 ± 13.5	< 0.001
Diastolic BP (mmHg)	77.7 ± 8.8	74.8 ± 9.5	< 0.001
Fatty liver on abdominal USG	809 (48%)	1014 30%)	< 0.001
Fasting plasma glucose	98.4 ± 20.5	95.2 ± 17.2	< 0.001
HbAlc	5.6 ± 0.7	5.5 ± 0.6	0.001
Triglycerides (mg/dL, mean ± SD)	158.9 ± 110.4	123.5 ± 78.6	< 0.001
HDL-C (mg/dL) (mean ± SD)	54.1 ± 12.0	56.4 ± 12.8	< 0.001
HOMA2	2.41 ± 1.10	2.18 ± 0.89	< 0.001
H pylori positive	211/555 (38%)	498/922 (54%)	< 0.001
Education (college and higher)	894/1184 (75%)	1639/2391 (69%)	< 0.001

¹Reflux symptoms: Weekly heartburn and/or acid regurgitation;

²HOMA: Homeostasis model assessment estimates steady state beta cell function and insulin sensitivity.

Table 2 Multivariate analyses of the risk for erosive esophagitis by gender, smoking, hiatal hernia, reflux symptoms, metabolic syndrome, fatty liver on abdominal USG and HOMA

	Adjusted odds ratio	95% CI	P
Gender	0.29	0.25-0.35	< 0.001
Current smoking	1.60	1.39-1.83	< 0.001
Alcohol use (≥ 3-4/wk)	1.80	1.53-2.14	< 0.001
Hiatal hernia	3.27	1.87-5.70	< 0.001
Reflux symptoms1	1.57	1.28-1.94	< 0.001
Metabolic syndrome	1.25	1.04-1.49	0.017
Fatty liver on abdominal USG	1.39	1.20-1.60	< 0.001
HOMA2	0.91	0.85-0.98	0.011

¹Reflux symptoms: Weekly heartburn and/or acid regurgitation;

²HOMA: Homeostasis model assessment estimates steady state beta cell function and insulin sensitivity.

Table 3 Risk of individual components of metabolic syndrome for erosive esophagitis

	OR (95% CI)1	P	OR (95% CI)2	P
Increased waist circumference	1.46 (1.28-1.67)	< 0.001	1.33 (1.15-1.54)	< 0.001
Hypertension	1.22 (1.06-1.40)	0.006	1.16 (1.00-1.35)	0.047
DM or elevated FBS	1.09 (0.77-1.54)	0.627	0.95 (0.66-1.38)	0.798
Increased TG	1.98 (1.74-2.26)	< 0.001	1.47 (1.14-1.90)	0.003
Low HDL-C	0.67 (0.56-0.80)	< 0.001	0.90 (0.74-1.09)	0.267

FBS: Fasting blood sugar; TG: Triglycerides; HDL-C: High-density lipoprotein-cholesterol.

¹Unadjusted;

²Adjusted for gender, current smoking, hiatal hernia, reflux symptoms, alcohol use, fatty liver on abdominal USG, and HOMA.

Table 4 Associations of grade of erosive esophagitis, according to LA classification, with risk factors for erosive esophagitis n (%)

	Control (n = 3358)	A (n = 1326)	B (n = 328)	C or D (n = 25)	P for linear trend
Age (yr, mean ± SD)	45.2 ± 9.7	44.8 ± 9.7	46.4 ± 9.3	49.9 ± 10.7	0.094
Males	1991 (59)	1122 (85)	300 (92)	22 (88)	< 0.001
Current smoking	786 (23)	554 (42)	162 (49)	8 (32)	< 0.001
Alcohol use (≥ 3-4/wk)	387 (12)	251 (19)	101 (31)	8 (32)	< 0.001
Hiatal hernia	24 (0.2)	32 (2)	3 (1)	3 (12)	< 0.001
Reflux symptoms1	265 (8.0)	141 (11)	50 (15)	3 (12)	< 0.001
Metabolic syndrome	433 (13)	255 (19)	87 (27)	10 (40)	0.001
Fatty liver on Abdominal USG	1014 (30)	625 (47)	166 (51)	18 (72)	< 0.001
HOMA2 (mean ± SD)	2.18 ± 0.89	2.39 ± 1.10	2.50 ± 1.10	2.70 ± 1.12	0.007

¹Reflux symptoms: Weekly heartburn and/or acid regurgitation;

²HOMA: Homeostasis model assessment estimates steady state beta cell function and insulin sensitivity.

Table 5 Associations of grade of erosive esophagitis, according to LA classification, with individual components of the metabolic syndrome n (%)

	Control (n = 3358)	A (n = 1326)	B (n = 328)	C or D (n = 25)	P for linear trend1
Increased waist circumference	942 (28)	504 (38)	159 (48)	19 (76)	< 0.001
Hypertension	722 (22)	378 (29)	103 (31)	8 (32)	0.244
DM or elevated FBS	84 (2.5)	49 (4)	11 (3)	0	0.346
Increased TG	850 (25)	561 (42)	138 (42)	11 (44)	0.004
Low HDL-C	497 (15)	164 (12)	37 (11)	5 (20)	0.582

¹Adjusted for gender, current smoking, hiatal hernia, reflux symptoms, alcohol use, fatty liver on abdominal USG, and HOMA.