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Association of Vitamin D and Parathyroid Hormone With Barrett’s Esophagus

Rubenstein, Joel H. MD, MS*,†,‡; McConnell, Daniel PhD§; Beer, David G. PhD; Chak, Amitabh MD; Metko, Valbona MD; Clines, Gregory MD, PhD‡,#

doi: 10.1097/MCG.0000000000001124
ALIMENTARY TRACT: Original Articles
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Background: Esophageal adenocarcinoma has been inversely associated with exposure to ultraviolet radiation. This could be because of vitamin D deficiency or hyperparathyroidism promoting gastroesophageal reflux disease (GERD) and Barrett’s esophagus.

Aim: The aim of this study is to determine the association between parathyroid hormone (PTH) and vitamin D deficiency with GERD symptoms, erosive esophagitis, and Barrett’s esophagus.

Methods: We assayed banked serum for PTH and total 25-hydroxy vitamin D from a cross-sectional cohort. Logistic regression was performed to estimate the associations of vitamin D deficiency and hyperparathyroidism with GERD symptoms, erosive esophagitis, and Barrett’s esophagus.

Results: Sera from 605 men were assayed, including 150 with GERD, 216 with erosive esophagitis, 145 with Barrett’s esophagus, and 174 normal subjects. Contrary to our hypothesis, we found a strong inverse association between Barrett’s esophagus and hyperparathyroidism (odds ratio=0.516; 95% confidence interval=0.265, 1.01), and a trend toward an inverse association with vitamin D deficiency. We found no association between vitamin D deficiency or hyperparathyroidism with GERD symptoms or erosive esophagitis.

Conclusions: Contrary to our hypothesis, we found an inverse association between serum PTH and Barrett’s esophagus. Validation of the finding and the mechanism of that association deserves further study.

*Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center

Department of Internal Medicine, Division of Gastroenterology

Department of Surgery, Thoracic Surgery

#Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan Medical School

Veterans Affairs Ann Arbor Medical Center

§University of Michigan School of Public Health, Ann Arbor, MI

Case Western Reserve University Medical School, Cleveland, OH

Supported by a 2015 American College of Gastroenterology Clinical Research Award. In addition, J.H.R.’s effort was funded by the US Department of Veterans Affairs (I01 CX000899).

J.H.R.: study concept and design, analysis and interpretation of data, drafting the manuscript, statistical analysis, obtained funding; D.M.C. and V.M.: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content; D.G.B. and A.C.: study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content; G.C.: analysis and interpretation of data, critical revision of the manuscript for important intellectual content.

The authors declare that they have nothing to disclose.

Address correspondence to: Joel H. Rubenstein, MD, MS, VA Medical Center 111-D, 2215 Fuller Road, Ann Arbor, MI 48109 (e-mail: jhr@umich.edu).

Received March 13, 2017

Accepted July 19, 2018

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