Differences in the Insulin Resistance Levels Measured by HOMA-IR between Patients with Erosive and Non-Erosive Gastroesophageal Reflux Disease

BACKGROUND: Insulin resistance is the core of Metabolic Syndrome which carries a high risk for cardiovascular events. Insulin resistance had been reported to be higher in GERD patients than subjects without GERD, specifically in erosive esophagitis. Objective. To compare the degree of insulin resistance, using HOMA-IR index, between erosive and non-erosive reflux disease. METHODOLOGY: A cross-sectional study of 84 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between January 2017 and April 2017 at Cipto Mangunkusumo National Hospital in Jakarta. Gastroesophageal Reflux Disease Questionnaire (GERDQ) was used for subject recruitment. Homeostatic model assessment-insulin resistance (HOMA-IR) index was used to evaluate insulin sensitivity. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Bivariate analysis was used to determine HOMA-IR difference between esophagitis and non-esophagitis group. RESULTS: The median of HOMA-IR in all subjects was 1.46 (0.32-13.85). Mann-Whitney test revealed that HOMA-IR index was higher in patients with erosive esophagitis [median 1.74 (0.35-13.85)] than those without erosive esophagitis [median 1.21 (0.32-10.78)] (p=0.05). CONCLUSION: Insulin resistance is significantly higher in gastroesophageal reflux disease patients with esophageal erosions than in those without esophageal erosion.