Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2016, Article ID 7897390, 7 pages http://dx.doi.org/10.1155/2016/7897390
Clinical Study Erosive Esophagitis in the Obese: The Effect of Ethnicity and Gender on Its Association Albin Abraham,1 Seth Lipka,2 Rabab Hajar,1 Bhuma Krishnamachari,3 Ravi Virdi,2 Bobby Jacob,2 Prakash Viswanathan,1 and Paul Mustacchia1 1
Department of Gastroenterology, Nassau University Medical Center, East Meadow, NY 11554, USA Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA 3 Research Department, NYIT College of Osteopathic Medicine, Glen Head, NY 11545, USA 2
Correspondence should be addressed to Albin Abraham; [email protected]
Received 11 January 2016; Accepted 6 March 2016 Academic Editor: Per Hellstr¨om Copyright © 2016 Albin Abraham et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Data examining the association between obesity and erosive esophagitis (ErE) have been inconsistent, with very little known about interracial variation. Goals. To examine the association between obesity and ErE among patients of different ethnic/racial backgrounds. Methods. The study sample included 2251 patients who underwent esophagogastroduodenoscopy (EGD). The effects of body mass index (BMI) on ErE were assessed by gender and in different ethnic groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis. Results. The prevalence of ErE was 29.4% (661/2251). Overweight and obese subjects were significantly more likely to have ErE than individuals with a normal BMI, with the highest risk seen in the morbidly obese (OR 6.26; 95% CI 3.82–10.28; 𝑝 < 0.0001). Normal weight Black patients were less likely to have ErE as compared to Caucasians (OR 0.46; 95% CI 0.27–0.79; 𝑝 = 0.005), while the odds ratio comparing normal weight Hispanics to normal weight Whites was not statistically significant. No effect modification was seen between BMI and race/ethnicity or BMI and gender. Significant trends were seen in each gender and ethnicity. Conclusions. The effect of BMI on ErE does not appear to vary by race/ethnicity or gender.
1. Introduction The prevalence of obesity, which has been defined as a body mass index (BMI) greater than 30 kg/m2 , has grown to epidemic proportions in the Western world, with an estimated $147 billion spent in annual healthcare costs . Associated complications from obesity have increased morbidity and mortality and have significantly decreased quality of life in such individuals [2, 3]. Data from the latest National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of obesity increased from 15% in 1976– 80 to 35.7% in 2009-10 [4, 5]. The highest rates of age adjusted obesity were found in non-Hispanic Blacks (49.5%) compared to non-Hispanic Whites (34.3%) and Hispanics (39.1%) . Similarly, the prevalence of gastroesophageal reflux disease (GERD) has been gradually rising in the United States, affecting up to 45% of the population, with at least
20% reporting weekly symptoms [6–9]. As a result, GERD imposes a tremendous burden on health care and in 2004 accounted for $12 billion in healthcare expenditure . Overall, though few studies have yielded conflicting results, obesity has been shown to be positively associated with GERD [5, 10–19]. However, the association between obesity and erosive esophagitis (ErE) has only been considered recently, and studies have yielded inconsistent results [11, 17, 20–26]. Hampel et al.  showed that obesity is overall associated with a significant risk of ErE, though a more recent meta-analysis demonstrated a strong association in males, but not in females . Though ErE has been reported to be more common among Caucasians [9, 29, 30], very little is known about effects of race on the association between increasing BMI and ErE, with no published data on the emerging Hispanic population. The objective of our study was to investigate the impact of obesity on ErE in different
2 genders and in various ethnic backgrounds, especially among the rapidly increasing Hispanic and Black population.
2. Methods 2.1. Study Design and Population. A retrospective case control study was designed to examine the association between obesity and ErE. The study population comprised 2,795 consecutive patients who underwent esophagogastroduodenoscopy (EGD) at Nassau University Medical Center (NUMC) in East Meadow, NY, between January 2011 and March 2013. NUMC, a 631-bed multidisciplinary teaching hospital, is part of the North Shore-Long Island Jewish (NSLIJ) Health System. In order to capture patients with significant symptoms for our study population and to maximize strength of our study, 544 patients were excluded for one or more of the following reasons: age