Obesity Linked to GERD's Complications

Summarized by Robert W. Griffith, MD
November 21, 2005

Introduction

Being overweight brings with it several health problems. One of these is an increased likelihood to develop gastroesophageal reflux disease, or GERD. Both GERD and its complications are on the increase, and so is overweight.

The main symptoms of GERD (heartburn after a meal, acid reflux) affect between 10% and 20% of adults in the USA; they may be accompanied by other symptoms or signs, such as hoarseness, chronic cough, asthma, laryngitis, recurrent pneumonia and ENT infections, sleep apnea, loss of dental enamel, and bad breath.

The complications of GERD, although rare, include esophagitis, Barrett's esophagus, and cancer of the esophagus.

Just how common are GERD and these complications in people who are really overweight - the obese? A new meta-analysis, just published in the nnals of Internal Medicine, reports on this; we summarize the findings here.

What was done

The medical literature was searched for full published studies covering obesity, GERD, and its complications. The selected studies had to provide risk estimates, and meet certain quality standards. And they had to give information on body size, i.e. data to estimate the body mass index, or BMI. For the meta-analysis, the results of selected studies were pooled and statistically analyzed.

What was found

Nine studies out of 370 originally selected were found to be suitable for these analyses. Six of them showed a significant link between obesity and GERD, while 3 showed no such association. People who were overweight (BMI between 25 and 30) were 1.5 times as likely, and those who were obese (BMI over 30) were twice as likely to develop GERD, compared with normal-weight people. These findings were unaffected by adjustments made for age, sex, anti-inflammatory medications, alcohol use, coffee drinking, dietary fiber, and total calorie intake.

Six of 7 studies found a significant link between BMI and erosive esophagitis, which is an inflammation of the lining of the esophagus, and a known complication of untreated acid reflux disease. There are differing grades of severity of erosive esophagitis, which can only be detected by an endoscopic exam. In this analysis, those with a BMI above 25 were 1.7 times as likely to develop erosive esophagitis as normal-weight individuals.

In 6 of 7 studies (which included two from China) there was a significant link between BMI scores and esophageal or stomach cancer. The likelihood of esophageal cancer for overweight persons was 1.5 times, and for obese individuals 2.8 times increased, compared with normal-weight people.

There was insufficient data to analyze any increased risk of Barrett's esophagus (a condition where GERD results in a change in the type of cells lining the lower esophagus, and which can sometimes advance to esophageal cancer).

What these findings mean

The findings for the effects of overweight and obesity on the occurrence of GERD were not surprising, but they allowed a reliable indication of the magnitude of the risk - a doubling for the likelihood of GERD in obese people.

While the degree of increased risk is similar for erosive esophagitis and cancer of the esophagus, it must be remembered that these complications of GERD are only seen in a small proportion of GERD patients: around 15% of GERD patients will be found to have erosive esophagitis of one degree or another; 10% of patients with GERD develop Barrett's esophagus; and of patients with Barrett's esophagus, 1% develop esophageal adenocarcinoma. So the actual chances of developing cancer of the esophagus following GERD are relatively small (about 1%). Nevertheless, halving the risk by avoiding obesity seems a worthwhile goal.

The main conclusion to be drawn from this analysis is the benefit to be derived from avoiding overweight or obesity, both by the elimination of the unpleasant symptoms of GERD, and by steering clear of its complications.

Source

• Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. HH. Hampel , ANS. Abraham , EHB. El-Serag ,  et al., Ann Intern Med, 2005, vol. 143, pp. 199--211

Related Links
GERD or GORD, It's Still a Pain
International Foundation for Functional Gastrointestinal Disorders: About GERD

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.