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Tuesday, 5 August 2014

Obesity Complication of Gastroesophageal Reflux Disease (Heart Burn)

By Kyle J. Norton

Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

How to calculate your BMI index
BMI= weight (kg)/ height (m2)

 Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease." by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.

D. How Obesity associates with Gastroesophageal Reflux Disease (Heart Burn)
1. According to the study of "Prevalence and risk factors for gastroesophageal reflux disease in an impoverished minority population" by Friedenberg FK, Rai J, Vanar V, Bongiorno C, Nelson DB, Parepally M, Poonia A, Sharma A, Gohel S, Richter JE., posted in PubMed, researchers found that Increasing waist circumference, but not overall body mass index or waist-hip ratio, and smoking are risk factors for prevalent GERD. No association between reflux disease and lifestyle choices such as coffee drinking and fast food dining were found.

2. In a study of "Does BMI affect the clinical efficacy of proton pump inhibitor therapy in GERD? The case for rabeprazole" by Pace F, Coudsy B, Delemos B, Sun Y, Xiang J, Lococo J, Casalini S, Li H, Pelosini I, Scarpignato C., posted in PubMed, researchers comcluded that Results of this study show that the clinical efficacy of rabeprazole is maintained in overweight/obese patients with gastroesophageal reflux disease and suggest that this subgroup of patients may derive, from rabeprazole, even greater benefit than lean patients.

3. In the abstract of the study of "Effects of environment and lifestyle on gastroesophageal reflux disease" by Sonnenberg A., posted in PubMed, researchers stated that Overweight and obesity contribute to the development of hiatal hernia, increase intra-abdominal pressure, and promote gastroesophageal reflux. Weight gain increases reflux symptoms, whereas weight loss decreases such symptoms. Other risk factors, such as smoking, alcohol, dietary fat, or drugs, play only a minor role in shaping the epidemiologic patterns of GERD. PROTECTION THROUGH HELICOBACTER PYLORI: On a population level, a high prevalence of H. pylori infection is likely to reduce levels of acid secretion and protect some carriers of the infection against reflux disease and its associated complications.

4. According to the study of "Gastroesophageal reflux disease and morbid obesity: is there a relation?" by Fisichella PM, Patti MG., posted in PubMed, researchers found that Although many advances have been made in the understanding of the pathophysiology of GERD, many aspects of the pathophysiology of this disease in morbidly obese patients remain unclear. The following review describes the current evidence linking esophageal reflux to obesity, covering the pathophysiology of the disease and the implications for treatment of GERD in the obese patient.

5. In the abstract of the study of "Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms" by Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, DeMeester TR, Crookes PF., posted in PubMed, researchers found that An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI.

6. Etc.


Treatments of Obesity and Gastroesophageal Reflux Disease (Heart Burn)
1. According to the study of "Gastroesophageal reflux disease is inversely related with glycemic control in morbidly obese patients" by Lauffer A, Forcelini CM, Ruas LO, Madalosso CA, Fornari F., posted in PubMed, researchers found that This study suggests an inverse relation between glycemic control and GERD in morbidly obese patients. This can be partially explained by a lower frequency of hiatal hernia in patients with very poor glycemic control.

2. In the study of "Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment" by Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG., posted in PubMed, researchers indicated that A linear regression model showed that BMI, LES pressure, LES abdominal length, and DEA were independently associated with the DeMeester score. These data showed that: (a) BMI was independently associated to the severity of GERD; and (b) in most morbidly obese patients with GERD, reflux occurred despite normal or hypertensive esophageal motility. These findings show that the pathophysiology of GERD in morbidly obese patients might differ from that of nonobese patients, suggesting the need for a different therapeutic approach.

3. Etc.

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