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Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms.
Eur J Gastroenterol Hepatol 2014; 26(1):6-10EJ

Abstract

OBJECTIVES

This study aimed to investigate the association between BMI and esophageal acid exposure in a cohort of patients referred for esophageal pH monitoring. The contributing roles of hiatal hernia, lower esophageal sphincter (LES) pressure, and intragastric pressure (IGP) were investigated, with an emphasis on reflux in the supine position.

METHODS

Esophageal manometry and 24-h pH-metry results were extracted from a prospectively collected database, and supplemental data (body mass, endoscopy results) from patient files.

RESULTS

In total, 245 patients (mean age 52.2±14 years, 54% men) were included in this study. In the normal-weight subgroup (n=87), the median acid exposure time was 1.1% [0-8.1] in the supine position (with interquartile range 25-75%) and 7.7% [2.5-14.8] in the upright position; the total acid exposure time was 7.4% [2.7-11.7]/24 h. In the overweight subgroup (n=104), the median acid exposure time was 4.9% [0.3-13.3] in the supine position and 11.1% [5.4-16.9] in the upright position; the total acid exposure time was 8.9% [4.7-15.8]/24 h. In the obesity subgroup (n=54), the median acid exposure time was 4.1% [0.7-14.3] in the supine position and 10.5% [5-17.5] in the upright position; the total acid exposure time was 8.3% [5.3-14.7]/24 h. Supine acid exposure was significantly higher in overweight and obese patients than in normal-weight patients (both P=0.02). In overweight patients, a hiatal hernia was predictive of supine and total acid exposure, as was a decreasing LES pressure in both the supine and the upright position. In obese patients, increased IGP contributed toward an increased total acid exposure. Although an association between increasing BMI and acid exposure was observed, BMI was not independently predictive.

CONCLUSION

Overweight and obesity is associated with increased reflux, especially in the supine position. The most important factors that contribute toward reflux are the presence of a hiatal hernia and a lower LES pressure in overweight patients and an increased IGP in obese patients.

Authors+Show Affiliations

aDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht bDepartment of Gastroenterology and Hepatology, Slingeland Hospital Doetinchem, Doetinchem cDepartment of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam dDutch Obesity Clinic Hilversum, Hilversum, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24025979

Citation

Burgerhart, Jan S., et al. "Nocturnal and Daytime Esophageal Acid Exposure in Normal-weight, Overweight, and Obese Patients With Reflux Symptoms." European Journal of Gastroenterology & Hepatology, vol. 26, no. 1, 2014, pp. 6-10.
Burgerhart JS, van de Meeberg PC, Siersema PD, et al. Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur J Gastroenterol Hepatol. 2014;26(1):6-10.
Burgerhart, J. S., van de Meeberg, P. C., Siersema, P. D., & Smout, A. J. (2014). Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. European Journal of Gastroenterology & Hepatology, 26(1), pp. 6-10. doi:10.1097/MEG.0b013e328365c3cb.
Burgerhart JS, et al. Nocturnal and Daytime Esophageal Acid Exposure in Normal-weight, Overweight, and Obese Patients With Reflux Symptoms. Eur J Gastroenterol Hepatol. 2014;26(1):6-10. PubMed PMID: 24025979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. AU - Burgerhart,Jan S, AU - van de Meeberg,Paul C, AU - Siersema,Peter D, AU - Smout,André J P M, PY - 2013/9/13/entrez PY - 2013/9/13/pubmed PY - 2014/7/22/medline SP - 6 EP - 10 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 26 IS - 1 N2 - OBJECTIVES: This study aimed to investigate the association between BMI and esophageal acid exposure in a cohort of patients referred for esophageal pH monitoring. The contributing roles of hiatal hernia, lower esophageal sphincter (LES) pressure, and intragastric pressure (IGP) were investigated, with an emphasis on reflux in the supine position. METHODS: Esophageal manometry and 24-h pH-metry results were extracted from a prospectively collected database, and supplemental data (body mass, endoscopy results) from patient files. RESULTS: In total, 245 patients (mean age 52.2±14 years, 54% men) were included in this study. In the normal-weight subgroup (n=87), the median acid exposure time was 1.1% [0-8.1] in the supine position (with interquartile range 25-75%) and 7.7% [2.5-14.8] in the upright position; the total acid exposure time was 7.4% [2.7-11.7]/24 h. In the overweight subgroup (n=104), the median acid exposure time was 4.9% [0.3-13.3] in the supine position and 11.1% [5.4-16.9] in the upright position; the total acid exposure time was 8.9% [4.7-15.8]/24 h. In the obesity subgroup (n=54), the median acid exposure time was 4.1% [0.7-14.3] in the supine position and 10.5% [5-17.5] in the upright position; the total acid exposure time was 8.3% [5.3-14.7]/24 h. Supine acid exposure was significantly higher in overweight and obese patients than in normal-weight patients (both P=0.02). In overweight patients, a hiatal hernia was predictive of supine and total acid exposure, as was a decreasing LES pressure in both the supine and the upright position. In obese patients, increased IGP contributed toward an increased total acid exposure. Although an association between increasing BMI and acid exposure was observed, BMI was not independently predictive. CONCLUSION: Overweight and obesity is associated with increased reflux, especially in the supine position. The most important factors that contribute toward reflux are the presence of a hiatal hernia and a lower LES pressure in overweight patients and an increased IGP in obese patients. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/24025979/Nocturnal_and_daytime_esophageal_acid_exposure_in_normal_weight_overweight_and_obese_patients_with_reflux_symptoms_ L2 - http://Insights.ovid.com/pubmed?pmid=24025979 DB - PRIME DP - Unbound Medicine ER -