Introduction: Esophageal adenocarcinoma has been associated with decreased exposure to ultraviolet radiation, suggesting a link with vitamin D (vit D) deficiency. We are not aware of prior studies of the effect of vit D deficiency on esophageal reflux, but it is associated with idiopathic gastroparesis. In addition, vit D deficiency can lead to hyperparathyroidism, which is linked to adipose tissue inflammation. We hypothesized that vit D deficiency is associated with gastroesophageal reflux disease (GERD) symptoms, erosive esophagitis, and Barrett''s Esophagus Study recruited men aged 50-79 undergoing colon cancer screening to undergo upper endoscopy regardless of symptoms (n = 822), classifying them as erosive esophagitis, BE, or neither. In addition, 80 men diagnosed with BE for the first time were enrolled. Subjects had the circumference of their waist and hips measured, and were queried regarding symptoms of GERD, PPI use, and supplemental use of calcium and vit D. We assayed serum for parathyroid hormone (PTH) and total 25-OH vit D from all subjects with BE, erosive esophagitis, or at least weekly symptoms of GERD, and a random sample of subjects without any of those conditions. Logistic regression was used to estimate the odds of hyperparathyroidism (PTH > 65 pg/mL) or vit D deficiency (< 20 ng/mL) with at least weekly GERD symptoms, erosive esophagitis, or BE.
Results: 605 men were selected for assay, including 150 with GERD, 216 with erosive esophagitis, and 145 with BE (groups not mutually exclusive), plus 174 normals. We found no evidence of an association between GERD symptoms or erosive esophagitis with vit D deficiency or hyperparathyroidism (Table). Contrary to our hypothesis, we found a strong inverse association between BE and hyperparathyroidism (OR = 0.588; 95% CI = 0.362, 0.956). Likewise, there was a trend toward an inverse association between BE and vit D deficiency.
Conclusion: We found no evidence of an association between vit D deficiency or hyperparathyroidism with GERD symptoms or erosive esophagitis, but found evidence for inverse associations between BE and hyperparathyroidism or vit D deficiency. If vit D deficiency is truly associated with esophageal adenocarcinoma, then it likely exerts its effect on the transition from BE to esophageal adenocarcinoma. Funding: 2015 ACG Clinical Research Award. Table 1:
Logistic Regression of Vitamin D Deficiency and Hyperparathyroidism on GERD Symptoms, Erosive Esophagitis, and Barrett''s E-mail is Invalid