Abdominal obesity has been associated with increased risk of Barrett's esophagus (BE) but the underlying mechanism is unclear.
Dr Hashem El-Serag and colleagues from Texas, USA examined the association between visceral adipose tissue and subcutaneous adipose tissue and the risk of BE.
A case-control study among eligible patients scheduled for elective esophagastroduodenoscopy (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 standardized mid-abdomen non-contrast computerized axial tomography images, which were analyzed by semiautomated image segmentation software.
The researchers analyzed the effect of visceral adipose tissue and subcutaneous adipose tissue surface areas and their ratio on BE.
|Large amount of visceral abdominal fat is associated with an increase in the risk of BE|
The research team reported that 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 visceral adipose tissue to subcutaneous adipose tissue ratio than colonoscopy controls, especially for those long segment BE, and for white men.
The researchers found that 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.
Dr El-Serag's team concludes, "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."