臺灣民眾肥胖與逆流性食道炎之相關性研究

The Relationship between Obesity and Reflux Esophagitis in a Taiwanese Population

目的：以胃鏡檢查做為逆流性食道炎診斷之研究不多，過去研究指出全身性肥胖與逆流性食道炎相關，身體質量指數愈高者，愈容易有逆流性食道炎的發生。但中心性肥胖與逆流性食道炎之相關性研究很少，因此本研究想探討台灣人全身性及中心性肥胖與逆流性食道炎之相關性。方法：本研究以1997年7月至2007年10月間至某國立醫學中心接受住院健康檢查及胃鏡檢查者共5,567位受檢者為研究對象，其中男性受檢者共3,232位，約佔58.1%；女性受檢者共2,335位，佔41.9%，其平均年齡約50.2±12.7歲。每位皆接受結構式自填問卷調查，並由專業護理人員測量身高、體重及腰圍。全身性肥胖之定義為身體質量指數大於等於25公斤／公尺平方，而中心性肥胖之定義為男性腰圍大於等於90公分或女性腰圍大於等於80公分。逆流性食道炎之診斷係以洛杉磯分類法為標準。結果：本研究發現逆流性食道炎之盛行率為19.5%，且男性比女性有較高比例之逆流性食道炎（24.7% vs. 12.3%，p<0.001）。單變項分析顯示，於男性中，有逆流性食道炎者較無逆流性食道炎者，年齡較輕，有較高的體重、身高、身體質量指數、腰圍、臀圍、較低的收縮壓，及較高比例的食道裂孔赫尼亞、中心性肥胖、吸菸、喝酒、及嚼檳榔習慣；於女性中，有逆流性食道炎者較無逆流性食道炎者，有較高的體重、身體質量指數、腰圍、臀圍。經多變項複邏輯迴歸統計分析後，在男性，有食道裂孔赫尼亞（勝算比：17.823）和全身性肥胖（勝算比：1.328）者較易產生逆流性食道炎；在女性，僅發現有食道裂孔赫尼亞者（勝算比：56.633）較易產生逆流性食道炎。但年齡、吸菸、喝酒及茶、嚼檳榔習慣與逆流性食道炎則無統計上的相關。結論：全身性肥胖、男性、及食道裂孔赫尼亞者較易有逆流性食道炎。臨床上對全身性肥胖的逆流性食道炎病人應常規性測量身體質量指數，同時應注重體重的減輕。

Purpose: Few studies have examined the relationship between central obesity and reflux esophagitis. The aim of this study was to investigate this relationship in a Taiwanese population. Methods: In all, 5,567 subjects (males 3,232, females 2,335, respectively; mean age, 52.2±12.7 years) received health check-ups and pan-endoscopic examinations from July 1997 to October 2007 at our medical center. Each subject completed a structured questionnaire, and body height, body weight, and waist circumference were measured by well-trained nurses. General obesity was defined according to WHO Asian-Pacific criteria, and central obesity was defined as waist circumference of 90 centimeters or more in males and 80 centimeters or more in females. Reflux esophagitis was diagnosed endoscopically and its severity was graded according to the Los Angeles classification. Results: The prevalence of reflux esophagitis was 19.5%. There were more male subjects than female subjects with reflux esophagitis (24.7% vs. 12.3%, p＜0.001). A higher percentage of male subjects with reflux esophagitis than male subjects without reflux esophagitis were younger, taller, and heavier, and had a hiatal hernia, habits of tobacco smoking, alcohol drinking, and betel nut chewing, and greater body mass index, waist and hip circumference, and central obesity. A higher percentage of female subjects with reflux esophagitis than female subjects without reflux esophagitis had a hiatal hernia, and higher body weight, body mass index, and waist and hip circumference. Multiple logistic regression showed that hiatal hernia (odds ratio: 17.823), and general obesity (odds ratio: 1.328) were independently associated with reflux esophagitis in males, and only hiatal hernia (odds ratio: 56.633) was independently associated with reflux esophagitis in females. However, age, smoking, alcohol drinking, betel nut chewing, and tea drinking habits were not independently related to reflux esophagitis after adjusting for other variables. Conclusion: General obesity, male gender, and hiatal hernia are independently related to reflux esophagitis. Body mass index (BMI) of patients with reflux esophagitis should be routinely measured and reduction in BMI, not just body weight, should be recommended.