Abstract
Obesity has increased dramatically in the last 30 years, affecting 33% of the adult population in the United States. Increase in body mass index has been shown to be associated with the increase in the prevalence of gastroesophageal reflux disease (GERD) symptoms, esophageal mucosal injury, and GERD complications. The putative mechanisms responsible for the close relationship between GERD and increased body mass index include increased intragastric pressure, increased gastroesophageal pressure gradient, esophageal motor and sensory abnormalities, increase in prevalence of hiatal hernia, increase in serum female hormonal levels, diet, and increase in comorbidities. Whilst the current efforts are to focus on one major underlying mechanism, it is highly likely that multiple factors contribute to the increased prevalence of GERD in the obese patient.
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Ogden KCL, Yanovski SZ, Carroll MD, Flegal KM (2007) The epidemiology of obesity. Gastroenterology 132:2087–2102
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP (1999) The spread of the obesity epidemic in the United States, 1991–1998. JAMA 283:1519–1522
Vasan RS, Pencina MJ, Cobain M, Frieberg MS, D’Agostino RB (2005) Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med 143:473–480
Parikh NI, Pencina MJ, Wang TJ, Lanier KJ, Fox CS, D’Agostino RB et al (2007) Increasing trends in incidence of overweight and obesity over 5 decades. Am J Med 120:242–250
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
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
Aro P, Ronkainen J, Talley NJ, Storskrubb T, Bolling-Sternevald E, Agréus L (2005) Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study. Gut 54:1377–1383
Ponce J, Vegazo O, Beltrán B, Jiménez J, Zapardiel J, Calle D et al (2006) Iberge Study Group: prevalence of gastro-oesophageal reflux disease in Spain and associated factors. Aliment Pharmacol Ther 23:175–184
Nocon M, Labenz J, Willich SN (2006) Lifestyle factors and symptoms of gastro-oesophageal reflux—a population-based study. Aliment Pharmacol Ther 23:169–1674
Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR 3rd, Rodriguez-Artalejo F (2004) Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population. Aliment Pharmacol Ther 19:95–105
Fass R, Quan SF, O’Connor GT, Ervin A, Iber C (2005) Predictors of heartburn during sleep in a large prospective cohort study. Chest 127:1658–1666
Rey E, Moreno-Elola-Olaso C, Artalejo FR, Locke GR 3rd, Diaz-Rubio M (2006) Association between weight gain and symptoms of gastroesophageal reflux in the general population. Am J Gastroenterol 101:229–233
Fraser-Moodie CA, Norton B, Gornall C, Magnago S, Weale AR, Holmes GK (1999) Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol 34:337–340
Melissas J, Christodoulakis M, Spyridakis M, Schoretsanitis G, Michaloudis D, Papavasiliou E et al (1998) Disorders associated with clinically severe obesity: significant improvement after surgical weight reduction. South Med J 91:1143–1148
Kaltenbach T, Crockett S, Gerson LB (2006) Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 166:965–971
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
Kulig M, Nocon M, Vieth M, Leodolter A, Jaspersen D, Labenz J et al (2004) Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the ProGERD study. J Clin Epidemiol 57:580–589
El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005) Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 100:1243–1250
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
Shapiro M, Green C, Faybush EM, Esquivel RF, Fass R (2006) The extent of oesophageal acid exposure overlap among the different gastro-oesophageal reflux disease groups. Aliment Pharmacol Ther 15:321–329
Fisher BL, Pennathur A, Mutnick JL, Little AG (1999) Obesity correlates with gastroesophageal reflux. Dig Dis Sci 44:2290–2294
Kouklakis G, Moschos J, Kountouras J, Mpoumponaris A, Molyvas E, Minopoulos G (2005) Relationship between obesity and gastroesophageal reflux disease as recorded by 3-hour esophageal pH monitoring. Rom J Gastroenterol 14:117–121
El-Serag HB, Ergun GA, Pandolfino JE, Fitzgerald S, Tran T, Kramer JR (2007) Obesity increases esophageal acid exposure. Gut 56:749–755
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
Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94:2840–2844
Wu AH, Tseng CC, Bernstein L (2003) Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma. Cancer 98:940–948
Jaffin BW, Knoepflmacher P, Greenstein R (1999) High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg 9:390–395
Quiroga E, Cuenca-Abente F, Flum D, Dellinger EP, Oelschlager BK (2006) Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: an evaluation with multichannel intraluminal impedance. Surg Endosc 20:739–743
Wu JCY, Mui LM, Cheung CMY, Chan Y, Sung JJ (2007) Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology 132:883–889
Mercer CD, Wren SF, DaCosta LR, Beck IT (1987) Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med 18:135–146
Sugerman HJ, DeMaria EJ, Felton WL 3rd, Nakatsuka M, Sismanis A (1997) Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 49:507–511
El-Serag HB, Tran T, Richardson P, Ergun G (2006) Anthropometric correlates of intragastric pressure. Scand J Gastroenterol 41:887–891
Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ (2006) Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 130:639–649
Corley DA, Kubo A, Zhao W (2007) Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut 56:756–762
Day JP, Richter JE (1990) Medical and surgical conditions predisposing to gastroesophageal reflux disease. Gastroenterol Clin North Am 19:587–607
Nilsson M, Lundergardh G, Carling W, Ye W, Lagergren J (2002) Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gastroenterol 37:626–630
Hautanen A (2000) Synthesis and regulation of sex hormone binding globulin in obesity. Int J Obes 24(suppl 2):64–70
Rubenstein JH, Dahlkemper A, Kao JY et al (2007) Low plasma adiponectin is associated with Barrett’s esophagus, controlling for reflux symptoms. Gastroenterology 132(suppl), 2(4):S57–S58
Halleux CM, Takahashi M, Delporte ML, Detry R, Funahashi T, Matsuzawa Y et al (2001) Secretion of adiponectic and regulation of apM1 gene expression in human visceral adipose tissue. Biochem Biophys Res Commun 288:1102–1107
Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE et al (2001) Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 86:1930–1935
Kazumi T, Kawaguchi A, Sakai K, Hirano T, Yoshino G (2002) Young men with high-normal blood pressure have lower serum adiponectin, smaller LDL size, and higher elevated heart rate than those with optimal blood pressure. Diabetes Care 25:971–976
Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T (2007) The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 5:439–444
Shapiro M, Green C, Bautista JM, Dekel R, Risner-Adler S, Whitacre R et al (2007) Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 25:93–101
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
Feinle C, Grundy D, Read NW (1995) Fat increases vection-induced nausea indpendent of changes in gastric emptying. Physiol Behav 58:1159–1165
Barbera R, Feinle C, Read NW (1995) Nutrient-specific modulation of gastric mechanosensitivity in patients with functional dyspepsia. Dig Dis Sci 40:1636–1641
Meyer JH, Lembo A, Elashoff JD, Fass R, Mayer EA (2001) Duodenal fat intensifies the perception of heartburn. Gut 49:624–628
Stiennon O (1985) The longitudinal muscle in esophageal disease. WRS Press, Madison
Herr J (2001) Chronic cough, sleep apnea, and gastroesophageal reflux disease. Chest 120:1036–1037
Samelson CF (1989) Gastroesophageal reflux and obstructive sleep apnea. Sleep 12:475–476
Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004) Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2:761–768
Kim HN, Vorona RD, Winn MP, Doviak M, Johnson DA, Ware JC (2005) Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients. Aliment Pharmacol Ther 21:1127–1133
Acknowledgments
Dr. Fass receives research support from AstraZeneca, Wyeth, TAP, and Ocera; he is a speaker for AstraZeneca and a consultant for TAP, Eisai, AstraZeneca, Vecta, Santaurus, Xenoport, and Dynnogen. 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.
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Fass, R. The Pathophysiological Mechanisms of GERD in the Obese Patient. Dig Dis Sci 53, 2300–2306 (2008). https://doi.org/10.1007/s10620-008-0411-y
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DOI: https://doi.org/10.1007/s10620-008-0411-y