Original ResearchFull Report: Clinical—Alimentary TractAssociations of Diabetes Mellitus, Insulin, Leptin, and Ghrelin With Gastroesophageal Reflux and Barrett's Esophagus
Section snippets
Study Design
We conducted a case-control study of 822 male CRC screenees, aged 50−79 years, presenting for colonoscopy at either the University of Michigan Health System's East Ann Arbor Medical Procedures Center or the Ann Arbor Veterans Affairs Medical Center. We recruited the CRC screenees to undergo upper endoscopy regardless of GERD symptoms, and we prospectively classified them on the basis of BE. BE was identified in 70 men (8.5%). In addition, we recruited 80 men aged 50−79 years who had recently
Results
A total of 1308 male CRC screenees were recruited to undergo upper endoscopy, of which 1202 were eligible, and 851 were enrolled (consent rate 71%). Eight hundred and twenty-two completed the esophagogastroduodenoscopy; 29 were withdrawn from the study due to impact on the clinical throughput of the endoscopy unit (n = 12), the inability to adequately sedate for the procedures (n = 10), exclusion criteria identified after consent (n = 4), or the patient withdrawing consent (n = 3).
Compared with
Discussion
We estimated the effects of diabetes mellitus, serum insulin, leptin, and ghrelin on GERD and BE in men. We found an inverse association of ghrelin with GERD symptoms and erosive esophagitis. Insulin was associated with BE, but its effect appeared to be modified by GERD: hyperinsulinemia was positively associated with BE only among those with GERD. Leptin was also associated with BE, and its effect also appeared to be stronger among men with GERD symptoms. Contrary to our hypothesis, we found a
Acknowledgments
Brenda Vibbart assisted with administration of the grants and clerical work. Donald May, Jeffrey Cole, and Jeffrey Holden assisted with administration of the grants. We greatly appreciate the assistance of the endoscopists and staff at the University of Michigan and the Ann Arbor Veterans Affairs Medical Center for performing and assisting with the research upper endoscopies and biopsies as well as technical support from Kim Gonzalez, Sara Kitzsteiner and Russell Possley at the CLASS Laboratory.
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Conflicts of interest The authors disclose no conflicts.
Funding Research and salary funding was provided for JHR by the Damon Runyon Cancer Research Foundation Gordon Family Clinical Investigator Award (CI: 36-07). JMS was supported by a Senior Mentoring Grant from the American Society for Gastrointestinal Endoscopy. JMI was supported by grant number K24 DK080941, and JYK was supported by grant number R01DK087708, both from the National Institute of Diabetes and Digestive and Kidney Diseases. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or other funding sources.