The association between obesity, helicobacter pylori infection, and endoscopy reflux esophagitis: A cross-sectional analysis of 450 patients

Aim To assess the independent associations of body mass index (BMI) and H. pylori infection with RE in a clinical cohort. Methods This cross-sectional study enrolled 450 patients undergoing endoscopy. RE was diagnosed and graded (A-C) per the Los Angeles classification. H. pylori status was determined by histology and/or rapid urease test. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) for RE. Results The prevalence of RE was 26.2% (118/450). Patients with RE were significantly older (49.2 vs. 46.5 years, p = 0.049) and had a lower prevalence of H. pylori infection (43.2% vs. 59.9%, p < 0.001) compared to those without RE. The distribution of BMI categories differed markedly (p < 0.001), with a higher proportion of obese patients (BMI ≥ 28 kg/m ² ) in the RE group (39.0% vs. 23.2%). In the multivariable analysis, obesity was a strong independent risk factor (aOR 3.12, 95% CI 1.71–5.68, p < 0.001), while H. pylori infection was an independent protective factor (aOR 0.50, 95% CI 0.32–0.77, p = 0.002). A dose-response relationship was observed for BMI. Conclusion Our findings confirm that obesity is a strong independent risk factor for RE, whereas H. pylori infection appears to be an independent protective factor in this population. These findings suggest that weight management may be a relevant target for RE prevention, although this hypothesis requires confirmation in prospective interventional studies.