Gastroesophageal reflux disease (GERD) of obese patients

Background: Increased intraabdominal pressure, shortened length of lower esophageal sphincter (LES), transitory LES relaxation, and the increased incidence of hiatus hernia are well established in patients with morbid obesity. The aims of our study were 1. to determine the incidence of erosive reflux disease (ERD) in these patients, 2. to quantify the healing rate of obese GERD patients, and 3. to determine the incidence of esophageal motility disorders in different BMI (normal, overweight, obese, morbid obese) groups.

Methods: 1. Healing study: 18 patients (male/female: 11/7, median age: 50.1; 28–74) were recruited into the study. The incidence of erosive esophagitis, and macroscopic healing was determined by esophagoscopy performed 0–4-8–12 weeks after the initial endoscope and treatment (1×PPI) initiation. A questionnaire related to GERD symptoms was filled out before the endoscopic examinations. 2. Motility study: 61 patients (male/female: 23/32, median age: 53.4; 21–85) were recruited into the study. Depending on the BMI, normal, overweight, obese, morbid obese subgroups were formed. Esophageal manometry was performed and the competence of LES, and esophageal body functions were analyzed.

Results: The incidence of ERD is similar in both groups; however the endoscopic healing rate (67% vs. 100%) and the disappearance of symptoms (60% vs. 87%) were lower in obese patients than in controls. Manometric findings:

Body Mass Index	20–24.9 n=17	25–29.9 n=26	30–34.9 n=10	35– n=8
Incompetent LES	10 (58.82%)	19 (73.08%)	9 (90.00%)	3 (37.50%)
Defective e. body:	6 (35.29%)	12 (46.15%)	3 (30.00%)	3 (37.50%)

Conclusions: Obese patients seem to require more aggressive treatment of GERD. The lower healing rate can be explained by the increased incidence of incompetent antireflux barrier and not by the decreased emptying of the esophageal body.

Grand support: ETT550/2003