Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus

A case-control study

Hashem B. El-Serag, Ali Hashmi, Jose Garcia, Peter Richardson, Abeer Alsarraj, Stephanie Fitzgerald, Marcelo Vela, Yasser Shaib, Neena S. Abraham, Maria Velez, Rhonda Cole, Margot B. Rodriguez, Bhupinderjit Anand, David Y. Graham, Jennifer R. Kramer

Research output: Contribution to journalArticle

57 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)220-229
Number of pages10
JournalGut
Volume63
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

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Barrett Esophagus
Abdominal Obesity
Case-Control Studies
Intra-Abdominal Fat
Subcutaneous Fat
Colonoscopy
Gastroesophageal Reflux
Proton Pump Inhibitors
Logistic Models
Abdomen
Endoscopy
Primary Health Care
Software
Tomography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

El-Serag, H. B., Hashmi, A., Garcia, J., Richardson, P., Alsarraj, A., Fitzgerald, S., ... Kramer, J. R. (2014). Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: A case-control study. Gut, 63(2), 220-229. https://doi.org/10.1136/gutjnl-2012-304189

Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus : A case-control study. / El-Serag, Hashem B.; Hashmi, Ali; Garcia, Jose; Richardson, Peter; Alsarraj, Abeer; Fitzgerald, Stephanie; Vela, Marcelo; Shaib, Yasser; Abraham, Neena S.; Velez, Maria; Cole, Rhonda; Rodriguez, Margot B.; Anand, Bhupinderjit; Graham, David Y.; Kramer, Jennifer R.

In: Gut, Vol. 63, No. 2, 02.2014, p. 220-229.

Research output: Contribution to journalArticle

El-Serag, HB, Hashmi, A, Garcia, J, Richardson, P, Alsarraj, A, Fitzgerald, S, Vela, M, Shaib, Y, Abraham, NS, Velez, M, Cole, R, Rodriguez, MB, Anand, B, Graham, DY & Kramer, JR 2014, 'Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: A case-control study', Gut, vol. 63, no. 2, pp. 220-229. https://doi.org/10.1136/gutjnl-2012-304189
El-Serag, Hashem B. ; Hashmi, Ali ; Garcia, Jose ; Richardson, Peter ; Alsarraj, Abeer ; Fitzgerald, Stephanie ; Vela, Marcelo ; Shaib, Yasser ; Abraham, Neena S. ; Velez, Maria ; Cole, Rhonda ; Rodriguez, Margot B. ; Anand, Bhupinderjit ; Graham, David Y. ; Kramer, Jennifer R. / Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus : A case-control study. In: Gut. 2014 ; Vol. 63, No. 2. pp. 220-229.
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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.",
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T1 - Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus

T2 - A case-control study

AU - El-Serag, Hashem B.

AU - Hashmi, Ali

AU - Garcia, Jose

AU - Richardson, Peter

AU - Alsarraj, Abeer

AU - Fitzgerald, Stephanie

AU - Vela, Marcelo

AU - Shaib, Yasser

AU - Abraham, Neena S.

AU - Velez, Maria

AU - Cole, Rhonda

AU - Rodriguez, Margot B.

AU - Anand, Bhupinderjit

AU - Graham, David Y.

AU - Kramer, Jennifer R.

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N2 - 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.

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