Non alcoholic fatty liver disease: prevalence of gastroesophageal refux disease symptoms

Background and aim: Non alcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) are two common gastrointestinal disorders. We investigated if a relation exists between GERD symptoms (GERD-S) and NAFLD. Material and methods: Cross-sectional retrospective study (Jan 2012-Sep 2013). Inclusion criteria: 1) presence of fatty liver at ultrasonography,2) absence of any etiological liver disease,3) no alcohol use (<20 g/day). NAFLD group: 206 pts (85M-121F, median age of 56–IQR44-67); control group: 183 pts (71M-112F, median age of 51, IQR 37-65). Information about: sex, age, weight, smoking, coffee, alcohol use, blood pressure, fasting plasma glucose, serum lipid profile, AST, ALT, g-GT. Severity and frequency of GERD-S: as pts referred (heartburn, regurgitation, belching, dysphagia, non-cardiac chest pain, epigastric pain, nausea, vomiting, cough, drooling, hoarse voice). If an upper endoscopy had been performed: assessment of lower esophageal sphincter incontinence, hiatal hernia, erosive esophagitis, gastritis. Results: The prevalence rate of GERD-S was higher in the NAFLD group than in the controls (at least one of GERD-S: 61.2% NAFLD pts vs 27.9% controls, p<0.001). We found a positive association between the presence of NAFLD and the experiencing of heartburn (OR: 4.29; 95% CI: 2.69–6.83), regurgitation (OR: 3.05; 95% CI: 1.89–4.92), both heartburn and regurgitation (OR: 2.91; 95% CI: 1.77–4.77) and belching (OR: 2.93; 95% CI: 1.83–4.71). In the NAFLD group, the prevalence of GERD-S was related to body mass index, BMI (OR: 1.05; 95% CI: 1.03–1.09) and coexisting metabolic syndrome status, MS (OR: 1.96; 95% CI: 1.05–3.15). A strong association persisted after adjustment for all the others covariates (adjusted OR: 3.49; 95% CI: 2.24–5.44). Conclusions: Our data suggest that the prevalence of GERD-S as heartburn and regurgitation is higher in pts with NAFLD. The higher prevalence of GERD-S in NAFLD pts was associated with higher BMI and MS, but not with age, l-HDL levels and diabetes mellitus type 2. In the multivariate analysis, NAFLD remained strongly associated with GERD-S, independently of all the features of MS. Consisting with these findings, MS can be considered as ashared background of the two diseases, but cannot completely explain the mechanisms of this correlation. We suggest that NAFLD can be an independent risk factor for GERD-S. Further studies are needed to understand the role of NAFLD in development of GERD-S.