Women who are obese are at a significantly increased risk of developing Barrett's oesophagus, researchers reported here at Digestive Diseases Week 2008 (DDW).
Dr. Jacobson and colleague Charles S. Fuchs, MD, Associate Professor of Medicine, Harvard Medical School, Boston, analysed data on 18,428 women participating in the Nurses' Health Study, a large prospective cohort study ongoing since 1976.
All the women had undergone oesophagogastroduodenoscopy (EGD); at the same time, they were each asked if they had been diagnosed with Barrett's oesophagus and about the presence and frequency of heartburn/acid-reflux symptoms.
The investigators obtained and reviewed endoscopy and pathology records from the women reporting Barrett's oesophagus, and they used data from oesophageal biopsy to identify cases with specialised intestinal metaplasia (SIM).
The researchers excluded women reporting Barrett's oesophagus who did not have documented SIM and women with a history of cancer before 1980.
The researchers categorised the women by their BMI in 1980 (<25,>30 kg/m2), and they used standard statistical models to calculate the odds ratios (ORs) and 95% confidence intervals (CI) for the risk of Barrett's oesophagus. They adjusted their calculations for age and potential confounding variables as reported in 1980, including physical activity, smoking, menopause status, postmenopausal hormone use, diabetes, and intake of calories, alcohol, coffee, tea, soda, and chocolate.
The investigators reported that, among 18,428 women who underwent EGD, 763 reported having Barrett's oesophagus, and 255 were confirmed to have SIM diagnosed after 1980.
They found that the mean Barrett's oesophagus segment length was 1.7 cm.
Compared with women with a BMI <25,>30 had an OR of 1.62 (95% CI, 1.08-2.42).
Notably, a history of frequent reflux symptoms was significantly associated with Barrett's oesophagus (multivariate OR = 2.79; 95% CI, 1.96-3.97).
When the investigators added symptoms of gastro-oesophageal reflux to the multivariate model, the relation between BMI and Barrett's oesophagus was markedly reduced (OR = 1.22; 95% CI, 0.72-2.08 for women with BMI >30).
The researchers found that height, waist-to-hip ratio, and waist circumference were not significantly associated with Barrett's oesophagus.
The authors concluded, "Obesity (BMI >30 kg/m2) is associated with a significant increase in the risk of Barrett's oesophagus. This risk appears to be mediated through gastro-oesophageal reflux."
Source: Digestive Diseases Week