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Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: a case-control study
  1. Hashem B El-Serag1,2,
  2. Ali Hashmi2,
  3. Jose Garcia3,
  4. Peter Richardson1,4,
  5. Abeer Alsarraj1,2,4,
  6. Stephanie Fitzgerald1,2,4,
  7. Marcelo Vela2,
  8. Yasser Shaib2,
  9. Neena S Abraham2,
  10. Maria Velez2,
  11. Rhonda Cole2,
  12. Margot B Rodriguez5,
  13. Bhupinderjit Anand2,
  14. David Y Graham2,
  15. Jennifer R Kramer1,4
  1. 1Houston VA HSR&D Center of Excellence Section, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  3. 3Department of Endocrinology, Metabolism and Diabetes, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  4. 4Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  5. 5Department of Radiology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to dr Hashem B El-Serag, Houston VA HSR&D Center of Excellence Section of Health Services Research, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030, USA; hasheme{at}bcm.edu

Abstract

Objective Abdominal obesity has been associated with increased risk of Barrett's oesophagus (BE) but the underlying mechanism is unclear. We examined the association between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the risk of BE.

Design A case-control study among eligible patients scheduled for elective oesophagastroduodenoscopy (EGD) and in a sample of patients eligible for screening colonoscopy recruited at the primary care clinic. All cases with definitive BE and a random sample of controls without BE were invited to undergo standardised mid-abdomen non-contrast computerised axial tomography images, which were analysed by semiautomated image segmentation software. The effect of VAT and SAT surface areas and their ratio (VAT to SAT) on BE were analysed in logistic regression models.

Results A total of 173 BE cases, 343 colonoscopy controls and 172 endoscopy controls underwent study EGD and CT scan. Participants with BE were more than twice as likely to be in the highest tertile of VAT to SAT ratio (OR: 2.42 (1.51 to 3.88) and adjusted OR 1.47 (0.88 to 2.45)) than colonoscopy controls, especially for those long (≥3 cm) segment BE (3.42 (1.67 to 7.01) and adjusted OR 1.93 (0.92 to 4.09)) and for white men (adjusted OR 2.12 (1.15 to 3.90)). Adjustment for gastroesophageal reflux disease (GERD) symptoms and proton pump inhibitors (PPI) use attenuated this association, but there was a significant increase in BE risk even in the absence of GERD or PPI use.

Conclusions Large amount of visceral abdominal fat relative to subcutaneous fat is associated with a significant increase in the risk of BE. GERD may mediate some but not all of this association.

  • Epidemiology
  • Obesity

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