Gastroesophageal reflux in asymptomatic obese subjects: An esophageal impedance-pH study

Akyüz, Filiz; Uyanıkoğlu, Ahmet; Ermış, Fatih; Arici, Serpil; Akyüz, Ümit; Baran, Bülent; Pınarbaşı, Binnur; Gül, Nurdan

doi:10.3748/wjg.v21.i10.3030

Cited by 19 publications

(21 citation statements)

References 14 publications

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“…investigated the presence of heartburn in 275 patients with confirmed reflux esophagitis and found that 28.5% of these patients had silent GERD with no typical symptoms. The study by Akyüz et al 30. revealed a correlation between acid reflux and BMI in 46 asymptomatic obese individuals.…”

Section: Discussionmentioning

confidence: 95%

Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?

et al. 2017

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Background/AimsTo evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure.MethodsWe conducted a cross-sectional study of 58 patients: 30 MO (cases) and 28 non-MO (controls). Esophageal symptoms and esophageal sensitivity to 0.1 M hydrochloric acid solution (Bernstein test) were compared between MO and non-MO patients with a prior diagnosis of abnormal esophageal acid exposure.ResultsMO patients were less symptomatic than non-MO controls (14% vs 96%; odds ratio [OR], 0.006; 95% confidence interval [CI], 0.001 to 0.075; p=0.000). MO patients were more likely to present with decreased esophageal sensitivity to the instillation of acid than non-MO controls (57% vs 14%; OR, 8; 95% CI, 1.79 to 35.74; p=0.009). Subgroup analysis revealed no differences in esophageal sensitivity in MO patients with and without abnormal esophageal acid exposure (43% vs 31%; p=0.707).ConclusionsSilent gastroesophageal reflux disease (GERD) is common among MO individuals, likely due to decreased esophageal sensitivity to acid. The absence of typical GERD symptoms in these patients may delay discovery of precancerous conditions, such as Barrett’s esophagus. We believe that these patients may require a more aggressive diagnostic work-up to rule out the presence of silent GERD.

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Section: Discussionmentioning

confidence: 95%

Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?

et al. 2017

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“…A study from Ricci et al reported increased acid reflux episodes in obese symptomatic and asymptomatic individuals in comparison to non-obese healthy individuals [19]. Recently, Akyuz et al reported the results of 24h MIIpH in asymptomatic obese subjects revealing a positive correlation between BMI and the number of reflux episodes [20]. In the previous study population consisted of individuals with much lower BMI (30.64 kg/m 2 ) than ours and 46 % of them had endoscopic findings of esophagitis.…”

Section: Discussionmentioning

confidence: 95%

“Normal Values of 24H Multichannel Intraluminal Impedance pH-Metry in a Greek Obese Population Based on Montreal Definition of Gerd”

et al. 2015

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Our study is the first to provide normal values of 24h MIIpH of asymptomatic obese. Normal values of 24h MIIpH of obese asymptomatic individuals differ from the reported normal values of non-obese healthy individuals; having more reflux episodes and equal or slightly higher median bolus exposure and acid clearance. Our results imply that new cut-off values should be employed in order to define GERD in obese individuals.

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“…19,[31][32][33][34] Third, obesity, or an increased volume of visceral fat, which is a common condition in patients with NAFLD, might increase gastric pressure leading to frequent lower oesophageal sphincter relaxation and acid reflux. [35][36][37][38][39][40] F I G U R E 3 Subgroup analysis of the effect of NAFLD on the risk of GERD stratified by the measures of effect for the outcome (with or without covariate adjustment) F I G U R E 4 Funnel plot of the standard error by log odds ratio for the risk of GERD among patients with NAFLD (for all studies, n = 9: cross-sectional and cohort studies were marked differently in the funnel plot). Egger's regression test: P < .001 | 7 of 8…”

Section: Discussionmentioning

confidence: 99%

Nonalcoholic fatty liver disease increases the risk of gastroesophageal reflux disease: A systematic review and meta‐analysis

Xue

Hua

Ren

et al. 2019

Eur J Clin Investigation

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Background Increasing evidence indicates that nonalcoholic fatty liver disease (NAFLD) is linked to an increased risk of extra‐hepatic conditions. However, it is currently uncertain whether NAFLD is associated with the risk of gastroesophageal reflux disease (GERD). We performed a systematic review and meta‐analysis of relevant studies to examine the association between NAFLD and the risk of GERD. Methods We searched PubMed, Scopus, Embase and Web of Science from 1 January 1975 to 15 December 2018, using predefined terms to identify cross‐sectional, case‐control and cohort studies investigating the association between NAFLD and GERD. Results Nine observational studies involving 185 118 subjects were eligible for inclusion in the meta‐analysis. Overall, NAFLD was significantly associated with an increased risk of GERD (random effect OR 1.28; 95% CI: 1.12‐1.44, I2 = 82%). Moreover, the significant association between NAFLD and GERD was consistent both for studies with adjusted OR/HR (n = 6, random effect OR = 1.16, 95% CI: 1.03‐1.30) and those with unadjusted OR/HR (n = 3, random effect OR = 2.09, 95% CI: 1.62‐2.56) as measures of effect. Both funnel plot and Egger's test suggested the existence of publication bias. However, a sensitivity analysis by sequentially omitting each study did not alter the pooled outcome,suggesting the robustness of the association. Conclusion NAFLD is associated with an increased risk of GERD. However, future large and cohort studies are still needed to determine the causal relationship between NAFLD and the risk of GERD.

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Gastroesophageal reflux in asymptomatic obese subjects: An esophageal impedance-pH study

Abstract: Acid reflux is correlated with BMI in asymptomatic obese individuals.

Cited by 19 publications

References 14 publications

Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?

Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?

“Normal Values of 24H Multichannel Intraluminal Impedance pH-Metry in a Greek Obese Population Based on Montreal Definition of Gerd”

Nonalcoholic fatty liver disease increases the risk of gastroesophageal reflux disease: A systematic review and meta‐analysis

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