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The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease.
Aliment Pharmacol Ther 2013; 37(5):555-63AP

Abstract

BACKGROUND

Obese patients have an increased risk of gastro-oesophageal reflux disease; however, the mechanism underlying this association is uncertain.

AIM

To test the hypothesis that mechanical effects of obesity on oesophageal function increase acid exposure and symptoms.

METHODS

Height, weight and waist circumference (WC) were measured in patients with typical reflux symptoms referred for manometry and 24 h ambulatory pH studies. Symptom severity was assessed by questionnaire. The association between obesity [WC, body mass index (BMI)], oesophageal function, acid exposure and reflux symptoms was assessed.

RESULTS

Physiological measurements were obtained from 582 patients (median age 48, 56% female) of whom 406 (70%) completed symptom questionnaires. The prevalence of general obesity was greater in women (BMI ≥ 30 kg/m(2) ; F 23%:M 16%; P = 0.056), however more men had abdominal obesity (WC ≥ 99 cm (M 41%:F 28%; P = 0.001)). Oesophageal acid exposure increased with obesity (WC: R = 0.284, P < 0.001) and was associated also with lower oesophageal sphincter (LOS) pressure, reduced abdominal LOS length and peristaltic dysfunction (all P < 0.001). Univariable regression showed a negative association of WC with both LOS pressure and abdominal LOS length (R = -0.221 and -0.209 respectively; both P < 0.001). However, multivariable analysis demonstrated that the effects of increasing WC on oesophageal function do not explain increased acid reflux in obese patients. Instead, independent effects of obesity and oesophageal dysfunction on acid exposure were present. Reflux symptoms increased with acid exposure (R = 0.300; P < 0.001) and this association explained increased symptom severity in obese patients.

CONCLUSIONS

Abdominal obesity (waist circumference) is associated with oesophageal dysfunction, increased acid exposure and reflux symptoms; however, this analysis does not support the mechanical hypothesis that the effects of obesity on oesophageal function are the cause of increased acid exposure in obese patients.

Authors+Show Affiliations

Oesophageal Laboratory, Guys and St Thomas' NHS Foundation Trust, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23305085

Citation

Anggiansah, R, et al. "The Effects of Obesity On Oesophageal Function, Acid Exposure and the Symptoms of Gastro-oesophageal Reflux Disease." Alimentary Pharmacology & Therapeutics, vol. 37, no. 5, 2013, pp. 555-63.
Anggiansah R, Sweis R, Anggiansah A, et al. The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2013;37(5):555-63.
Anggiansah, R., Sweis, R., Anggiansah, A., Wong, T., Cooper, D., & Fox, M. (2013). The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. Alimentary Pharmacology & Therapeutics, 37(5), pp. 555-63. doi:10.1111/apt.12208.
Anggiansah R, et al. The Effects of Obesity On Oesophageal Function, Acid Exposure and the Symptoms of Gastro-oesophageal Reflux Disease. Aliment Pharmacol Ther. 2013;37(5):555-63. PubMed PMID: 23305085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. AU - Anggiansah,R, AU - Sweis,R, AU - Anggiansah,A, AU - Wong,T, AU - Cooper,D, AU - Fox,M, Y1 - 2013/01/10/ PY - 2012/10/25/received PY - 2012/12/06/revised PY - 2012/12/21/accepted PY - 2012/12/20/revised PY - 2013/1/12/entrez PY - 2013/1/12/pubmed PY - 2013/7/19/medline SP - 555 EP - 63 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 37 IS - 5 N2 - BACKGROUND: Obese patients have an increased risk of gastro-oesophageal reflux disease; however, the mechanism underlying this association is uncertain. AIM: To test the hypothesis that mechanical effects of obesity on oesophageal function increase acid exposure and symptoms. METHODS: Height, weight and waist circumference (WC) were measured in patients with typical reflux symptoms referred for manometry and 24 h ambulatory pH studies. Symptom severity was assessed by questionnaire. The association between obesity [WC, body mass index (BMI)], oesophageal function, acid exposure and reflux symptoms was assessed. RESULTS: Physiological measurements were obtained from 582 patients (median age 48, 56% female) of whom 406 (70%) completed symptom questionnaires. The prevalence of general obesity was greater in women (BMI ≥ 30 kg/m(2) ; F 23%:M 16%; P = 0.056), however more men had abdominal obesity (WC ≥ 99 cm (M 41%:F 28%; P = 0.001)). Oesophageal acid exposure increased with obesity (WC: R = 0.284, P < 0.001) and was associated also with lower oesophageal sphincter (LOS) pressure, reduced abdominal LOS length and peristaltic dysfunction (all P < 0.001). Univariable regression showed a negative association of WC with both LOS pressure and abdominal LOS length (R = -0.221 and -0.209 respectively; both P < 0.001). However, multivariable analysis demonstrated that the effects of increasing WC on oesophageal function do not explain increased acid reflux in obese patients. Instead, independent effects of obesity and oesophageal dysfunction on acid exposure were present. Reflux symptoms increased with acid exposure (R = 0.300; P < 0.001) and this association explained increased symptom severity in obese patients. CONCLUSIONS: Abdominal obesity (waist circumference) is associated with oesophageal dysfunction, increased acid exposure and reflux symptoms; however, this analysis does not support the mechanical hypothesis that the effects of obesity on oesophageal function are the cause of increased acid exposure in obese patients. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/23305085/The_effects_of_obesity_on_oesophageal_function_acid_exposure_and_the_symptoms_of_gastro_oesophageal_reflux_disease_ L2 - https://doi.org/10.1111/apt.12208 DB - PRIME DP - Unbound Medicine ER -