Obesity Surgery

, Volume 20, Issue 6, pp 749–756 | Cite as

Quantitative Assessment of Visceral Fat in Morbidly Obese Patients by Means of Wide-Bore MRI and its Relation to Lower Esophageal Sphincter Pressure and Signs of Gastroesophageal Reflux

  • Fabian SpringerEmail author
  • Manuel Schwarz
  • Jürgen Machann
  • Andreas Fritsche
  • Claus D. Claussen
  • Fritz Schick
  • Joachim H. Schneider
Basic Science Research



The aim of this study was to quantitatively assess visceral adipose tissue (VAT) by means of a wide-bore MR scanner in a cohort of morbidly obese patients referred for bariatric surgery. Furthermore, it was investigated whether gastroesophageal reflux disease (GERD) and lower esophageal sphincter pressure (LESP) are related to the volume of visceral fat masses.


Twenty-five morbidly obese patients (nine male, 16 female) were prospectively enrolled. In addition to common anthropometric measures of obesity, VAT was determined quantitatively by multi-slice MRI. Symptoms of GERD were evaluated using a standardized questionnaire, while endoscopy of the upper gastrointestinal tract was performed to reveal pathologies of the gastroesophageal junction. LESP was evaluated by esophageal manometry.


Study population showed a body mass index (BMI) between 35.2 and 59.1 kg/m2. Waist-to-hip ratio and VAT were significantly higher (p < 0.0001; p = 0.0021) in males (1.05 ± 0.05; 8.89 ± 2.33 l) than in females (0.86 ± 0.07; 6.04 ± 1.28 l). VAT was not correlated to BMI. LESP values and GERD-related symptoms were neither dependent on anthropometric measures nor on VAT in our cohort.


VAT did not show a positive correlation with BMI in our cohort of extremely obese subjects, indicating a pronounced fat deposition in subcutaneous tissue compartment. Moreover, this indicates that VAT is limited to a gender-dependent maximum volume for each individual and seems to be no further increasing in extremely obese subjects. This might be the reason that neither symptoms nor endoscopic findings of GERD nor LESP were significantly influenced by the stage of morbid obesity.


Morbid obesity Visceral adipose tissue Subcutaneous adipose tissue Gastroesophageal reflux Endoscopy of upper gastrointestinal tract 



The authors have nothing to disclose which could lead to a potential conflict of interest regarding the submitted manuscript.


  1. 1.
    Machann J, Thamer C, Schnoedt B, et al. Age and gender related effects on adipose tissue compartments of subjects with increased risk for type 2 diabetes: a whole body MRI/MRS study. Magma. 2005;18:128–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Machann J, Thamer C, Schnoedt B, et al. Standardized assessment of whole body adipose tissue topography by MRI. J Magn Reson Imaging. 2005;21:455–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Friedenberg FK, Xanthopoulos M, Foster GD, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111–22.CrossRefPubMedGoogle Scholar
  4. 4.
    Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet. 2006;367:2086–100.CrossRefPubMedGoogle Scholar
  5. 5.
    Boeckxstaens GE. Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;26:149–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.CrossRefPubMedGoogle Scholar
  7. 7.
    El-Serag HB, Tran T, Richardson P, et al. Anthropometric correlates of intragastric pressure. Scand J Gastroenterol. 2006;41:887–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Chung SJ, Park MJ, Kim MJ, et al. Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut. 2008;57:1360–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastroesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Hampel HH, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.PubMedGoogle Scholar
  12. 12.
    Murray L, Johnston B, Lane A, et al. Relationship between body mass and gastro-esophageal reflux syptoms: the Bristol Helicobacter Project. Int J Epidemiol. 2003;32:645–50.CrossRefPubMedGoogle Scholar
  13. 13.
    Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41. quiz 311.CrossRefPubMedGoogle Scholar
  14. 14.
    Schneider JH, Crookes PF, Becker HD. Four-channel sleeve catheter for prolonged measurement of lower esophageal sphincter pressure. Dig Dis Sci. 1999;44:2456–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Bueter M, Thalheimer A, le Roux CW, et al. Upper gastrointestinal investigations before gastric banding. Surg Endosc. 2009. doi: 10.1007/s00464-009-0720-z
  16. 16.
    Oberg S, Peters JH, DeMeester TR, et al. Endoscopic grading of the gastroesophageal valve in patients with symptoms of gastroesophageal reflux disease (GERD). Surg Endosc. 1999;13:1184–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Csendes A, Smok G, Burdiles P, et al. Prevalence of intestinal metaplasia according to the length of the specialized columnar epithelium lining the distal esophagus in patients with gastroesophageal reflux. Dis Esophagus. 2003;16:24–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Oberg S, Peters JH, DeMeester TR, et al. Inflammation and specialized intestinal metaplasia of cardiac mucosa is a manifestation of gastroesophageal reflux disease. Ann Surg. 1997;226:522–30. discussion 30–2.CrossRefPubMedGoogle Scholar
  19. 19.
    Nocon M, Labenz J, Jaspersen D, et al. Association of body mass index with heartburn, regurgitation and esophagitis: results of the progression of gastroesophageal reflux disease study. J Gastroenterol Hepatol. 2007;22:1728–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Piretta L, Alghisi F, Anzini F, et al. Prevalence of overweightedness in patients with gastro-esophageal reflux. World J Gastroenterol. 2007;13:4602–5.PubMedGoogle Scholar
  21. 21.
    Jansson C, Nordenstedt H, Johansson S, et al. Relation between gastroesophageal reflux symptoms and socioeconomic factors: a population-based study (the HUNT Study). Clin Gastroenterol Hepatol. 2007;5:1029–34.CrossRefPubMedGoogle Scholar
  22. 22.
    Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med. 1991;151:448–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Kaltenbach T, Crockett S, Gerson L. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Sabaté JM, Jouet P, Merrouche M, et al. Gastroesophageal reflux in patients with morbid obesity: a role of obstructive sleep apnea syndrome? Obes Surg. 2008;18:1479–84.CrossRefPubMedGoogle Scholar
  25. 25.
    Herbella FAM, Sweet M, Tedesco P, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Surg Obesity. 2007;17:894–900.CrossRefGoogle Scholar
  28. 28.
    Fisher BL, Pennathur A, Mutnick JL, et al. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Jaffin BW, Knoepflmacher P, Greenstein R. High Prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Csendes A, Burdiles P, Rojas J. Pathological gastroesophageal reflux in patients with severe, morbid and hyper obesity. Rev Med Chil. 2001;129:1038–43.PubMedGoogle Scholar
  31. 31.
    Hong D, Khajanchee YS, Pereira N. Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese patients. Obes Surg. 2004;14:744–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Suter M, Dorta G, Giusti V. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.CrossRefPubMedGoogle Scholar
  33. 33.
    Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.CrossRefPubMedGoogle Scholar
  34. 34.
    Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.CrossRefPubMedGoogle Scholar
  35. 35.
    Schneider JH, Kuper M, Konigsrainer A, et al. Transient lower esophageal sphincter relaxation in morbid obesity. Obes Surg. 2009;19:595–600.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Fabian Springer
    • 1
    Email author
  • Manuel Schwarz
    • 2
  • Jürgen Machann
    • 1
  • Andreas Fritsche
    • 4
  • Claus D. Claussen
    • 3
  • Fritz Schick
    • 1
  • Joachim H. Schneider
    • 2
  1. 1.Section on Experimental Radiology, Department of Diagnostic and Interventional RadiologyUniversity Hospital TübingenTübingenGermany
  2. 2.Department of General, Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany
  3. 3.Department of Diagnostic and Interventional RadiologyUniversity Hospital TübingenTübingenGermany
  4. 4.Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical ChemistryUniversity Hospital TübingenTübingenGermany

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