In a recent publication in the Journal of Gastroenterology and Hepatology, researchers conducted a cohort study and sought to compare the risk of erosive esophagitis (EE) among individuals with different phenotypes, focusing on the status of metabolic health and obesity. The researchers also aimed to explore the role of shifts in metabolic health and its impact on the risk of developing EE.

The study was comprised of 258,892 asymptomatic adults aged 18 years and older without EE at the initial assessment who underwent follow-up esophagogastroduodenoscopy (EGD), and it was divided into four groups based on metabolic health and obesity status, including: 1) metabolically healthy (MH) nonobese, 2) metabolically unhealthy (MU) nonobese; 3) MH obese; and 4) MU obese. Moreover, EE was defined as the presence of grade A or higher mucosal breaks on EGD. The average age of participants was 38.4 years, with men comprising an estimated 53.5% of the study cohort.

The results revealed that among study participants,112,781 individuals were categorized as metabolically healthy nonobese (MHNO); 76,519 were classified as metabolically unhealthy nonobese (MUNO); 13,815 were classified as MH obese (MHO); and 55,777 were classified as MU obese (MUO). The corresponding prevalence of MHNO, MUNO, MHO, and MUO was 43.6%, 29.6%, 5.3%, and 21.5%, respectively.

During an average follow-up of 4.5 years, the rates of EE incidence were 0.6/103 person-years (PY), 1.7/103 PY, 1.7/103 PY, and 3.1/103 PY in the MH nonobese, MU nonobese, MH obese, and MU obese groups, respectively.

The authors also noted that the multivariable-adjusted hazard ratio (HR; 95% CI) for developing EE comparing individuals classified as MH obese, MU nonobese, and MU obese groups with the MH nonobese group were 1.49 (1.29-1.71), 1.56 (1.25-1.94), and 2.18 (1.90-2.49), respectively. Additionally, the multivariable-adjusted HR (95% CI) comparing the progression of MH to MU, regression of MU to MH, and persistent MU with the persistent MH group were noted as 1.39 (1.10-1.76),1.39 (1.09-1.77), and 1.86 (1.56-2.21), respectively. The results also revealed that in individuals without obesity or abdominal obesity, the augmented risk of EE among the persistent MU group was consistently observed.

During the follow-up period, 920 patients were suspected of having Barrett’s esophagus via endoscopy, but histological confirmation was not obtained. The majority of these cases were categorized as either short-segment or ultra-short–segment Barrett’s esophagus. The authors wrote, “The retrospective nature of the study and the use of deidentified data limited further classification, preventing a clear distinction between short-segment and ultra-short-segment Barrett’s esophagus.”

Based on their findings, the authors concluded, “Metabolic unhealthiness is an independent risk factor for the development of EE regardless of obesity status. Given the association between metabolic unhealthiness and EE, patients with EE may need to consider their metabolic health status.”

The authors also noted that additional large prospective studies are necessary to clarify whether enhancing metabolic health leads to EE regression or a decrease in developing EE and its manifestations.

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