August 22, 2019
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Esophageal symptom burden in obesity tied to reflux

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Esophageal symptoms in patients with obesity are caused by gastroesophageal reflux and not dysmotility, according to study results.

“Despite reports of increased prevalence of abnormal manometric diagnoses and esophageal reflux burden in obese individuals, relationships between esophageal symptom burden and objective data from esophageal testing remain incompletely understood,” C. Prakash Gyawali, MD, of the division of gastroenterology at Washington University School of Medicine in St. Louis, Missouri, and colleagues wrote. “In this retrospective, observational cohort study of consecutive patients referred for esophageal testing, we sought to evaluate relationships between BMI and esophageal symptom burden, [esophageal motor disorders] according to Chicago Classification and esophageal reflux burden.”

Researchers analyzed data from 1,089 patients who underwent high-resolution manometry over a 2-year period. Of those patients, 426 also underwent reflux monitoring off acid suppression. They assessed symptom burden using questionnaires to determine dominant symptom intensity (DSI; defined as symptom severity and frequency on 5-point Likert scales) and global symptom severity (GSS; global esophageal symptoms on a 10 cm visual analog scale). Finally, they compared proportions of patients with esophageal motor disorders and abnormal reflux burden among different BMI categories.

Gyawali and colleagues found that patients with obesity had a higher symptom burden compared with patients without obesity (DSI = 10.5±0.3 vs. 9.7±0.2; P = .03 and GSS = 6.5±1 vs. 5.9±1; P = .01). However, esophageal motor disorders were less frequent among patients with obesity.

In the group of 426 patients who underwent reflux monitoring, researchers found that proportions of patients with total acid exposure time and upright acid exposure time increased among the BMI categories. Additionally, BMI correlated with symptom burden, higher acid exposure time and positive symptoms association probability (P < .01 for all).

Gyawali and colleagues wrote that their findings show that higher symptom burden in patients with obesity is likely related to higher reflux exposure.

“Our data show a clear linear association between BMI and esophageal acid burden while demonstrating that symptom burden is correspondingly increased in relationship to reflux,” they wrote. “Our findings highlight the importance of clarifying esophageal reflux burden and motor function in symptomatic obese patients prior to invasive intervention for either obesity or reflux disease.” by Alex Young

Disclosures: Gyawali reports consulting for Ironwood, Quintiles and Torax, and receiving teaching and speaking fees from Diversatek and Medtronic. Please see the full study for all other authors’ relevant financial disclosures.