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Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study

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Abstract

Background

Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM.

Methods

Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry.

Results

A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m2, and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m2, were included. The proportions of patients reporting GERD-symptoms were low (< 29%) and did not differ significantly between groups, while the proportions of patients with esophagitis were high both in the T2DM and non-T2DM group, 58% versus 47%, p = 0.16. The majority of patients with esophagitis did not have GERD-symptoms (68–80%). Further, 55% of the patients with T2DM had pathologic acid reflux. Among these, 71% also had erosive esophagitis, whereof 67% were asymptomatic.

Conclusions

The prevalence of GERD was similar in bariatric patients with or without T2DM, and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2DM. Accordingly, GERD may be underdiagnosed in patients not undergoing a preoperative endoscopy or acid reflux assessment.

Trial Registration

Clinical Trials.gov number NCT01778738

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Acknowledgments

We express our sincere gratitude to the participants, the patient representative, and to the study personnel at the gastroenterology outpatient clinic. In addition, we thank Linda Mathisen, Berit Mossing Bjørkås, Andreas Aarvik, Heidi Omre Fon, Hanna Lakso, and Astrid Hillestad, for their continuous efforts, enthusiasm, and patient care, thereby ensuring the collection of high-quality data in the Oseberg study.

Funding

The study is organized and financed by the Vestfold Hospital Trust and the Morbid Obesity Centre. All employees receive a salary from their respective departments. JL has received a grant from the South-Eastern Norway Regional Health Authority.

Author information

Author notes

  1. Birgitte Seip and Jøran Hjelmesæth shared senior authorship and contributed equally to this work

Authors and Affiliations

  1. Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway

    Jolanta Lorentzen, Jens Kristoffer Hertel, Heidi Borgeraas, Tor-Ivar Karlsen, Ronette L. Kolotkin, Rune Sandbu, Dag Hofsø & Jøran Hjelmesæth

  2. Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway

    Jolanta Lorentzen, Dag Hofsø, Birgitte Seip & Jøran Hjelmesæth

  3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Jolanta Lorentzen

  4. Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway

    Asle W. Medhus

  5. Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway

    Tor-Ivar Karlsen

  6. Duke University School of Medicine, Durham, NC, USA

    Ronette L. Kolotkin

  7. Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway

    Rune Sandbu & Marius Svanevik

  8. Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Daniel Sifrim

  9. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Marius Svanevik & Jøran Hjelmesæth

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  1. Jolanta Lorentzen
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Corresponding author

Correspondence to Jolanta Lorentzen.

Ethics declarations

The study was registered in an international trial register (Clinical Trials. gov) https://clinicaltrials.gov/ct2/show/NCT01778738, and a protocol paper has been published previously [23].

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by the Regional Committees for Medical and Health Research Ethics in Norway (ref: 2012/1427/REK Sør-Øst B). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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Lorentzen, J., Medhus, A.W., Hertel, J.K. et al. Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study. OBES SURG 30, 2667–2675 (2020). https://doi.org/10.1007/s11695-020-04545-w

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  • DOI: https://doi.org/10.1007/s11695-020-04545-w

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