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Is Obesity a Risk Factor for Barrett’s Esophagus?

Prateek Sharma, MD, FASGE, reviewing Qumseya B, et al. Endoscopy 2020 Apr 23.

While the role of obesity in gastroesophageal reflux disease (GERD) and the role of GERD in Barrett’s esophagus (BE) are independently well established, there is an implied assumption that obesity plays a role in BE. The authors of this large systematic review and meta-analysis explored the association of body mass index (BMI) and risk of BE in patients who were undergoing evaluation for bariatric surgery. 

A total of 13,434 patients (ages, 36.7-46.3 years; BMI, 39-51.2 kg/m2; female, 54%-91% of participants) from 29 studies were included in the final analysis. The researchers reported there were only 114 cases of BE, with a pooled prevalence of only 0.9% (95% CI, 0.7%-1.3%). On meta-regression (n=10 studies), a weakly positive association between BMI and the prevalence of BE (β=0.15 [95% CI, 0.02-0.28]; P=.03) and a stronger association with BMI and GERD were noted (β=3.9 [95% CI, 0.4-7.5]; P=.03). The authors reported that study limitations included a lack of histopathological confirmation of BE in all studies, a patient population of mostly women, and an absence of information about endoscopist experience.

Prateek Sharma, MD, FASGE

COMMENT

Despite some of the study shortcomings, it is interesting to note that this cohort of obese patients undergoing bariatric evaluation not only had a low prevalence (0.9%) of BE but also a marginal risk of BE with increasing BMI (0.15% for each 1 kg/m2 increase in BMI). For comparison, the reported prevalence of BE in the general population is estimated to be around 0.8% to 1%. It is possible that other factors, such as abdominal circumference and metabolic syndrome features rather than obesity, play a role in BE.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Qumseya B, Gendy S, Wallace A, et al. Prevalence of Barrett’s esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis. Endoscopy 2020 Apr 23. (Epub ahead of print) (https://doi.org/10.1055/a-1145-3500)

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