Skip to main content

The Association Between Obesity and GERD: A Review of the Epidemiological Evidence

Abstract

The current epidemics of obesity and gastroesophageal reflux disease (GERD)-related disorders have generated much interest in studying the association between them. Results of multiple studies indicate that obesity satisfies several criteria for a causal association with GERD and some of its complications, including a generally consistent association with GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. An increase in GERD symptoms has been shown to occur in individuals who gain weight but continue to have a body mass index (BMI) in the normal range, contributing to the epidemiological evidence for a possible dose–response relationship between BMI and increasing GERD. Data are less clear on the relationship between Barrett’s esophagus (BE) and obesity. However, when considered separately, abdominal obesity seems to explain a considerable part of the association with GERD, including BE. Overall, epidemiological data show that maintaining a normal BMI may reduce the likelihood of developing GERD and its potential complications.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtain LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850 doi:10.1001/jama.291.23.2847

    PubMed  Article  CAS  Google Scholar 

  2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555. doi:10.1001/jama.295.13.1549

    PubMed  Article  CAS  Google Scholar 

  3. Dent J, El-Serag HB, Wallander MA, Johansson S (2005) Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 54:710–717. doi:10.1136/gut.2004.051821

    PubMed  Article  CAS  Google Scholar 

  4. Pohl H, Welch HG (2005) The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97:142–146

    PubMed  Article  Google Scholar 

  5. El-Serag HB (2007) Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 5:17–26. doi:10.1016/j.cgh.2006.09.016

    PubMed  Article  Google Scholar 

  6. Conio M, Cameron AJ, Romero Y, Branch CD, Schleck CD, Burgart LJ et al (2001) Secular trends in the epidemiology and outcome of Barrett’s oesophagus in Olmsted County, Minnesota. Gut 48:304–309. doi:10.1136/gut.48.3.304

    PubMed  Article  CAS  Google Scholar 

  7. van Soest EM, Dieleman JP, Siersema PD, Sturkenboom MC, Kuipers EJ (2005) Increasing incidence of Barrett’s oesophagus in the general population. Gut 54:1062–1066. doi:10.1136/gut.2004.063685

    PubMed  Article  Google Scholar 

  8. El-Serag HB (2002) The epidemic of esophageal adenocarcinoma. Gastroenterol Clin North Am 31:421–440

    Google Scholar 

  9. Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143:199–211

    PubMed  Google Scholar 

  10. Andersen LI, Jensen G (1991) Risk factors for benign oesophageal disease in a random population sample. J Intern Med 230:5–10

    PubMed  CAS  Article  Google Scholar 

  11. Lagergren J, Bergstrom R, Nyren O (2000) No relation between body mass and gastro-oesophageal reflux symptoms in a Swedish population based study. Gut 47:26–29. doi:10.1136/gut.47.1.26

    PubMed  Article  CAS  Google Scholar 

  12. Wu AH, Tseng CC, Bernstein L (2003) Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma. Cancer 98:940–948. doi:10.1002/cncr.11568

    PubMed  Article  Google Scholar 

  13. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J (2003) Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 290:66–72. doi:10.1001/jama.290.1.66

    PubMed  Article  CAS  Google Scholar 

  14. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354:2340–2348. doi:10.1056/NEJMoa054391

    PubMed  Article  CAS  Google Scholar 

  15. Nilsson M, Lundegardh G, Carling L, Ye W, Lagergren J (2002) Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gastroenterol 37:626–630. doi:10.1080/00365520212502

    PubMed  Article  CAS  Google Scholar 

  16. Stene-Larsen G, Weberg R, Frøyshov Larsen I, Bjørtuft O, Hoel B, Berstad A (1988) Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol 23:427–432. doi:10.3109/00365528809093890

    PubMed  Article  CAS  Google Scholar 

  17. Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94:2840–2844. doi:10.1111/j.1572-0241.1999.01426.x

    PubMed  Article  CAS  Google Scholar 

  18. Labenz J, Jaspersen D, Kulig M, Leodolter A, Lind T, Meyer-Sabellek W et al (2004) Risk factors for erosive esophagitis: a multivariate analysis based on the ProGERD study initiative. Am J Gastroenterol 99:1652–1656. doi:10.1111/j.1572-0241.2004.30390.x

    PubMed  Article  Google Scholar 

  19. Chang CS, Poon SK, Lien HC, Chen GH (1997) The incidence of reflux esophagitis among the Chinese. Am J Gastroenterol 92:668–671

    PubMed  CAS  Google Scholar 

  20. Furukawa N, Iwakiri R, Koyama T, Okamoto K, Yoshida T, Kashiwagi Y et al (1999) Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol 34:441–444. doi:10.1007/s005350050293

    PubMed  Article  CAS  Google Scholar 

  21. Ruhl CE, Everhart JE (1999) Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey. Ann Epidemiol 9:424–435. doi:10.1016/S1047-2797(99)00020-4

    PubMed  Article  CAS  Google Scholar 

  22. Vaughan TL, Davis S, Kristal A, Thomas DB (1995) Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 4:85–92

    PubMed  CAS  Google Scholar 

  23. Brown LM, Swanson CA, Gridley G, Swanson GM, Schoenberg JB, Greenberg RS et al (1995) Adenocarcinoma of the esophagus: role of obesity and diet. J Natl Cancer Inst 87:104–109. doi:10.1093/jnci/87.2.104

    PubMed  Article  CAS  Google Scholar 

  24. Zhang ZF, Kurtz RC, Sun M, Karpeh M Jr, Yu GP, Gargon N et al (1996) Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors. Cancer Epidemiol Biomarkers Prev 5:761–768

    PubMed  CAS  Google Scholar 

  25. Chow WH, Blot WJ, Vaughan TL, Risch HA, Gammon MD, Stanford JL et al (1998) Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 90:150–155

    PubMed  Article  CAS  Google Scholar 

  26. Lagergren J, Bergstrom R, Nyren O (1999) Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 130:883–890

    PubMed  CAS  Google Scholar 

  27. Cheng KK, Sharp L, McKinney PA, Logan RF, Chilvers CE, Cook-Mozaffari P et al (2000) A case-control study of oesophageal adenocarcinoma in women: a preventable disease. Br J Cancer 83:127–132. doi:10.1054/bjoc.2000.1121

    PubMed  Article  CAS  Google Scholar 

  28. Wu AH, Wan P, Bernstein L (2001) A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control 12:721–732. doi:10.1023/A:1011290704728

    PubMed  Article  CAS  Google Scholar 

  29. Corley DA, Kubo A (2006) Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol 101:2619–2628. doi:10.1111/j.1572-0241.2006.00539.x

    PubMed  Article  Google Scholar 

  30. Kubo A, Corley DA (2006) Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 15:872–878. doi:10.1158/1055-9965.EPI-05-0860

    PubMed  Article  Google Scholar 

  31. El-Serag HB, Kvapil P, Hacken-Bitar J, Kramer JR (2005) Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol 100:2151–2156. doi:10.1111/j.1572-0241.2005.00251.x

    PubMed  Article  Google Scholar 

  32. Stein DJ, El-Serag HB, Kuczynski J, Kramer JR, Sampliner RE (2005) The association of body mass index with Barrett’s oesophagus. Aliment Pharmacol Ther 22:1005–1010. doi:10.1111/j.1365-2036.2005.02674.x

    PubMed  Article  CAS  Google Scholar 

  33. Smith KJ, O’Brien SM, Smithers BM, Gotley DC, Webb PM, Green AC et al (2005) Interactions among smoking, obesity, and symptoms of acid reflux in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev 14(11 pt 1):2481–2486. doi:10.1158/1055-9965.EPI-05-0370

    PubMed  Article  Google Scholar 

  34. Gerson LB, Ullah N, Fass R, Green C, Shetler K, Singh G (2007) Does body mass index differ between patients with Barrett’s oesophagus and patients with chronic gastro-oesophageal reflux disease? Aliment Pharmacol Ther 25:1079–1086

    PubMed  CAS  Google Scholar 

  35. Corley DA, Kubo A, Levin TR, Block G, Habel L, Zhao W, Leighton P, Quesenberry C, Rumore GJ, Buffler PA (2007) Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology 133:34–41, quiz 311

    Google Scholar 

  36. Klauser AG, Schindlbeck NE, Muller-Lissner SA (1990) Symptoms in gastro-oesophageal reflux disease. Lancet 335:205–208. doi:10.1016/0140-6736(90)90287-F

    PubMed  Article  CAS  Google Scholar 

  37. Edelstein ZR, Farrow DC, Bronner MP, Rosen SN, Vaughan TL (2007) Central adiposity and risk of Barrett’s esophagus. Gastroenterology 133:403–411. doi:10.1053/j.gastro.2007.05.026

    PubMed  Article  Google Scholar 

  38. El-Serag HB, Petersen NJ, Carter J, Graham DY, Richardson P, Genta RM et al (2004) Gastroesophageal reflux among different racial groups in the United States. Gastroenterology 126:1692–1699. doi:10.1053/j.gastro.2004.03.077

    PubMed  Article  Google Scholar 

  39. Sonnenberg A, El-Serag HB (1999) Clinical epidemiology and natural history of gastroesophageal reflux disease. Yale J Biol Med 72:81–92

    PubMed  CAS  Google Scholar 

  40. Falk GW, Thota PN, Richter JE, Connor JT, Wachsberger DM (2005) Barrett’s esophagus in women: demographic features and progression to high-grade dysplasia and cancer. Clin Gastroenterol Hepatol 3:1089–1094. doi:10.1016/S1542-3565(05)00606-3

    PubMed  Article  Google Scholar 

  41. El-Serag HB, Mason AC, Petersen N, Key CR (2002) Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 50:368–372 10.1136/gut.50.3.368

    PubMed  Article  CAS  Google Scholar 

  42. Ogden CL, Flegal KM, Carroll MD, Johnson CL (2002) Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 288:1728–1732. doi:10.1001/jama.288.14.1728

    PubMed  Article  Google Scholar 

  43. Weinsier RL, Hunter GR, Gower BA, Schutz Y, Darnell BE, Zuckerman PA (2001) Body fat distribution in white and black women: different patterns of intraabdominal and subcutaneous abdominal adipose tissue utilization with weight loss. Am J Clin Nutr 74:631–636

    PubMed  CAS  Google Scholar 

  44. Corley DA, Kubo A, Zhao W (2007) Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut 56:756–762. doi:10.1136/gut.2006.109413

    PubMed  Article  Google Scholar 

  45. Castell DO (1996) Obesity and gastro-oesophageal reflux: Is there a relationship? Eur J Gastroenterol Hepatol 8:625–626

    PubMed  CAS  Google Scholar 

  46. El-Serag HB, Satia JA, Rabeneck L (2005) Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut 54:11–17. doi:10.1136/gut.2004.040337

    PubMed  Article  CAS  Google Scholar 

  47. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR 3rd, Rodiguez-Artalejo F (2004) Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther 19:95–105. doi:10.1046/j.1365-2036.2003.01769.x

    PubMed  Article  CAS  Google Scholar 

  48. Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd (1999) Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 106:642–649. doi:10.1016/S0002-9343(99)00121-7

    PubMed  Article  Google Scholar 

  49. Murray L, Johnston B, Lane A, Harvey I, Donovan J, Nair P et al (2003) Relationship between body mass and gastro-oesophageal reflux symptoms: the Bristol Helicobacter Project. Int J Epidemiol 32:645–650. doi:10.1093/ije/dyg108

    PubMed  Article  Google Scholar 

  50. El-Serag HB, Johanson JF (2002) Risk factors for the severity of erosive esophagitis in Helicobacter pylori-negative patients with gastroesophageal reflux disease. Scand J Gastroenterol 37:899–904. doi:10.1080/003655202760230847

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgment

Dr. El-Serag has served as a consultant for TAP Pharmaceuticals, AstraZeneca, Eisai, and Novartis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hashem El-Serag.

Additional information

The scientific roundtable was funded by Eisai Inc. and PriCara, a Unit of Ortho-McNeil, Inc. International Meetings and Science Inc. organized the roundtable and provided editorial support.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

El-Serag, H. The Association Between Obesity and GERD: A Review of the Epidemiological Evidence. Dig Dis Sci 53, 2307–2312 (2008). https://doi.org/10.1007/s10620-008-0413-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0413-9

Keywords

  • Gastroesophageal reflux disease
  • Obesity
  • Body mass index
  • Epidemiology