Risk of GERD-related disorders in obese patients on PPI therapy: a population analysis

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Title: Risk of GERD-related disorders in obese patients on PPI therapy: a population analysis
Authors: Erridge, S
Moussa, O
Ziprin, P
Purkayastha, S
Item Type: Journal Article
Abstract: Background Increasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study’s aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett’s esophagus (BE) and esophageal carcinoma. Method A case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside clinical endpoints of GERD, BE, and esophageal carcinoma. Multivariate analysis was utilized to identify factors that increase the propensity to develop BE and esophageal carcinoma. Statistical significance was p < 0.050. Results One hundred sixty five thousand nine hundred twenty nine obese patients on PPI treatment were identified up until July 2017. Median follow-up time was 119.0 months (range 11.3–1397.9 months). In patients with GERD, the following were associated with increased BE risk: age ≥ 60 years (OR = 1.197; p = 0.039), male (OR = 2.209; p < 0.001), H2 antagonists (OR = 1.377; p < 0.001), D2 antagonists (OR = 1.241; p = 0.008), and hiatus hernias (OR = 6.772; p = 0.017). The following were associated with increased risk of esophageal carcinoma: age (OR = 2.831; p = 0.031), male sex (OR = 3.954; p = 0.003), and hiatus hernias (OR = 12.170; p < 0.001). Only D2 antagonists (OR = 2.588; p = 0.002) were associated with increased risk of developing esophageal carcinoma in BE patients. Conclusions In obese patients on PPI therapy for reflux, higher BMIs were not associated with increased risk of BE or esophageal carcinoma. Males, older patients, and those with hiatus hernias are at increased risk of developing BE and carcinoma. Failure of PPI monotherapy is predictive of future metaplasia and dysplasia.
Issue Date: 1-Mar-2018
Date of Acceptance: 1-May-2018
URI: http://hdl.handle.net/10044/1/60798
DOI: https://dx.doi.org/10.1007/s11695-018-3246-4
ISSN: 0960-8923
Publisher: Springer Verlag
Start Page: 1
End Page: 8
Journal / Book Title: Obesity Surgery
Volume: 105
Copyright Statement: © 2018 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Barrett’s esophagus
Esophageal carcinoma
GERD
Obesity
11 Medical And Health Sciences
Publication Status: Published online
Conference Place: Univ Nottingham Med Sch, Nottingham, ENGLAND
Online Publication Date: 2018-05-01
Appears in Collections:Division of Surgery
Faculty of Medicine



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