Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: a case-control study

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.

The role of obesity in oesophageal cancer development

“…As discussed previously, obesity seems to promote the development of BO and OAC through reflux-dependent and -independent means, and epidemiologically the combination of obesity and reflux is a significantly greater risk than either alone or the additive effect [Duggan et al 2013;El-Serag et al 2014;Garcia et al 2014;Lagergren et al 1999]. This is reflected in further experimental data.…”

Austrian expert panel recommendation for radiofrequency ablation of Barrett’s esophagus

“…Increased cancer risk includes: long standing GERD (> 10 years), hiatal hernia > 3.0 cm, esophagitis, length of BE, history of BE with dysplasia, positive family history for esophageal and gastrointestinal cancer and obesity with an intraabdominal fat distribution [18][19][20][21][22]. RFA of NDBE should be conducted in specialized centers within clinical trials [23,24].…”

The Effect of Abdominal Visceral Fat, Circulating Inflammatory Cytokines, and Leptin Levels on Reflux Esophagitis

“…2,3 Several studies have suggested that abdominal obesity and visceral fat increased the risk of reflux esophagitis [4][5][6] or Barrett's esophagus. 7 Abdominal visceral adipose tissue not only mechanically disrupts the integrity of the gastroesophageal junction barrier and leads to increased esophageal reflux, 8 but also has a metabolic effect. 9 Abdominal visceral fat is metabolically active and increased inflammatory cytokines, insulin resistance, 9 and cardiovascular disease.…”