GERD-related disorders: risk factors in obese patients on proton pump inhibitors

Takeaway

• Increasing BMI beyond an obese baseline is not associated with increased risk for Barrett’s esophagus (BE) and esophageal carcinoma in obese patients receiving proton pump inhibitor (PPI) therapy.
• Men, older patients, those with hiatus hernia and in whom PPI monotherpay therapy fails are at increased risk of developing BE and carcinoma.

Why this matters

• PPIs are an effective treatment for symptomatic relief from reflux esophagitis; however, there is no clarity whether obese patients on PPI therapy still progress to develop gastroesophageal reflux disease (GERD)-related disorders.

Study design

• Population-based case-control study used data from the Clinical Practice Research Datalink (CPRD) in the United Kingdom and included obese patients (BMI ≥30 kg/m²) who received PPI therapy.
• Median follow-up: 119 months (range 11.3-1397.9 months).
• Funding: None disclosed.

Key results

• 165,929 obese patients receiving PPI treatment were identified on the CPRD up until July 2017.
• Of these, 42,356 patients were diagnosed with GERD, 2119 with BE and 60 with esophageal carcinoma.
• The following factors were associated with increased risk for BE in patients with GERD:
  • age ≥60 years (OR, 1.19; P=.039),
  • men (OR, 2.2; P<.001),
  • H2 antagonists (OR, 1.3; P<.001),
  • D2 antagonists (OR, 1.2; P=.008) and
  • hiatus hernias (OR, 6.7; P=.017).
• Age (OR, 2.8; P=.031), male gender (OR, 3.9; P=.003) and hiatus hernias (OR, 12.1; P<.001) were associated with increased probability of developing esophageal cancer.
• D2 antagonists (OR, 2.5; P=.002) use was the only factor associated with increased development from BE to esophageal cancer.

Limitations

• Risk for bias.
• Retrospective design.