Obesity impact on GER symptoms examined
MedWire News: Two teams of researchers at the Gastro 2009 meeting in London, UK, have shed light on the relationship between gastroesophageal reflux (GER) and obesity, finding individuals with a high body mass index (BMI) have an increased risk for symptoms.
B Coffin (Hôpital Louis Mourier, Colombes, France) and colleagues investigated whether abdominal obesity affects the severity or frequency of GER symptoms in 4739 patients attending 1699 family physicians.
The study included 2456 patients who had not received treatment for the GER symptoms of heart burn or regurgitation in the past 3 months, and 2456 age- and gender-matched patients without GER.
GER patients were asked to describe their symptoms in the 7 preceding days using 4-point intensity and 3-point frequency scales.
Analysis showed that among patients with GER, a waist circumference of 94 cm or above in men and 80 cm or above in women did not significantly predict frequency or intensity of heartburn, pain, regurgitation, belching, gastric fullness, nausea or vomiting, pharyngitis, or cough.
Nevertheless, patients with GER did weigh significantly more on average and had significantly higher BMI and larger waist circumferences than controls, Coffin et al note.
A second group of French researchers investigated the prevalence of GER symptoms in obese patients who were referred for bariatric surgery.
Although GER symptoms are frequently reported by patients who undergo bariatric surgery, the prevalence ofsymptoms before surgery is unknown, explained K Belhocine and co-workers, from 1 NSERM CIC 04, Universitare Hospital, Nantes.
To investigate further, the team asked patients with a BMI above 30 kg/m2 attending a single clinic for bariatric surgery referral to complete a questionnaire on GER digestive symptoms such as heartburn or regurgitation, and other symptoms that could be related to GER, such as cough, or ear, nose and throat symptoms.
Fifty-five patients, with an average BMI of 47 kg/m2, and an average age of 42 years, were enrolled and underwent upper gastrointestinal endoscopy, esophageal 24-hour pH monitoring, and high-resolution manometry.
Overall, 40 (72%) patients had manometric abnormalities, with 26 showing a hypotonic lower esophageal sphincter, 16 abnormal peristalsis, and 11 repeated waves. In addition, 21 patients had abnormal esophageal acid exposure. Five patients with GER and 12 without had a hiatal hernia.
Analysis revealed a significant and negative correlation between patient age and acid exposure, with an average age of 38 years in GER-positive and 44 years in GER-negative patients.
In addition, there was a positive and significant correlation between patient weight and the presence of hiatal hernia.
“The results observed in this group of obese patients referred for bariatric surgery show the high prevalence of symptoms suggestive of GERD (71%), as well as pathological esophageal acid exposure (38%),” Belhocine et al concluded.
“These results strongly justify the indication of a careful pre-operative work-up including symptom assessment and functional measurements. These data should be extremely useful to interpret postoperative disorders and their relation to either reflux or procedure.”
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By Lynda Williams