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Enhanced Levels of Insulin Resistance in Patients with Gastro-Esophageal Reflux Evaluated by Flat-Panel Detector Assisted Videoesophagography

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Iwasaki, Eisuke MD; Suzuki, Hidekazu MD, PhD; Sugino, Yoshinori MD, PhD; Nishizawa, Toshihiro MD; Masaoka, Tatsuhiro MD, PhD; Hibi, Toshifum MD, PhD, FACG

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S57
Abstracts: ESOPHAGUS
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Depertment of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Depertment of Emergency Medicine, Keio University School of Medicine, Tokyo, Japan and Depertment of Diagnostic Radiology Medicine, Keio University School of Medicine, Tokyo, Japan.

Purpose: Although it has been reported that both body mass index (BMI) and obesity were associated with symptoms of gastroesophageal reflux disease (N Engl J Med. 354: 2340, 2006, Ann Intern Med 143, 199, 2005), the relationship between insulin resistance and gastroesophageal reflux (GER) remains unclarified. The present study was designed to investigate the effect of insulin resistance on the levels of GER by using the originally developed flat panel detector-assisted videoesophagography.

Methods: Eighteen patients with GER symptoms were examined by the videoesophagography after the informed consent. On their initial visit, all patients were completed the Japanese version of the Carlsson- Dent self-administered questionnaire (Scand J Gastroenterol. 40: 1005, 2005). The findings of videoesophagography were evaluated by the Keio video X-ray reflux scores which were defined for the diagnosis of functional GER. Patients were classified into three groups according to the X-ray scores: low X-ray sore group (<3; N = 5), middle X-ray sore group (4–5; N = 6), and high X-ray sore group (>5; N = 7). Each score of videoesophagography, BMI, levels of serum adiponectin, triglyceride and glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) were examined.

Results: The X-ray score of videoesophagography was correlated with the total point of questionnaire in the overweight (BMI >24) patients. The levels of serum adiponectin (5.8 ± 2.5 μg/ml μg/ml) in the high X-ray score group decreased significantly as compared with those in the low groups (16.1 ± 3.6 μg/ml, p < 0.05). Metabolic markers (BMI 25.7 ± 2.4, HOMA-IR 1.5 ± 0.6, triglyceride 144.9 ± 64.4 mg/dl) in the high X-ray score group increased significantly as compared with those in the low group (BMI 22.5 ± 2.2, HOMA-IR 0.7 ± 0.4, triglyceride 68.2 ± 24 mg/dl, p < 0.05).

Conclusions: Decreased levels of serum adiponectin and increased levels of HOMA-IR were shown in patients with severe GER evaluated by videoesophagography, suggesting a possible link between insulin resistance and the severity of GER.

© The American College of Gastroenterology 2006. All Rights Reserved.