Frank Friedenberg and colleagues from Temple University, Philadelphia, PA, have reviewed the literature on this association in a paper just out in the American Journal of Gastroenterology.
Not only have nearly all epidemiologic studies found an association between increasing body mass index (BMI) and symptoms of GERD, this association may well be explained by changes in gastroesophageal anatomy and physiology directly caused by obesity.
These changes include
1) increased prevalence of esophageal motor disorders
2) diminished lower esophageal sphincter (LES) pressure
3) development of a hiatal hernia
4) increased intragastric pressure
Furthermore, central or abdominal adiposity may be the most important risk for the development of reflux and related complications such as Barrett’s esophagus and esophageal adenocarcinoma.
Surprisingly, weight loss, through caloric restriction and behavioral modification alone, has not been widely studied as a means of improving reflux.
On the other hand, bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), has been consistently associated with improvement in the symptoms and findings of GERD. According to the authors, laparoscopic adjustable gastric banding appears to have unfavorable effects on GERD and should be avoided in these patients.
Clearly, more needs to be done to better understand how obesity influences GERD and to further elucidate the mechanisms by which weight loss leads to improvements in this common ailment.
Frankfurt am Main, Germany