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Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis

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...

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Autores principales: Erridge, Simon, Moussa, Osama M., Ziprin, Paul, Darzi, Ara, Purkayastha, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132732/
https://www.ncbi.nlm.nih.gov/pubmed/29717405
http://dx.doi.org/10.1007/s11695-018-3246-4
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author Erridge, Simon
Moussa, Osama M.
Ziprin, Paul
Darzi, Ara
Purkayastha, Sanjay
author_facet Erridge, Simon
Moussa, Osama M.
Ziprin, Paul
Darzi, Ara
Purkayastha, Sanjay
author_sort Erridge, Simon
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11695-018-3246-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-61327322018-09-13 Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis Erridge, Simon Moussa, Osama M. Ziprin, Paul Darzi, Ara Purkayastha, Sanjay Obes Surg Original Contributions 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11695-018-3246-4) contains supplementary material, which is available to authorized users. Springer US 2018-05-01 2018 /pmc/articles/PMC6132732/ /pubmed/29717405 http://dx.doi.org/10.1007/s11695-018-3246-4 Text en © The Author(s) 2018 Open Access 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.
spellingShingle Original Contributions
Erridge, Simon
Moussa, Osama M.
Ziprin, Paul
Darzi, Ara
Purkayastha, Sanjay
Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title_full Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title_fullStr Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title_full_unstemmed Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title_short Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis
title_sort risk of gerd-related disorders in obese patients on ppi therapy: a population analysis
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132732/
https://www.ncbi.nlm.nih.gov/pubmed/29717405
http://dx.doi.org/10.1007/s11695-018-3246-4
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