Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study

Abstract

A wide variety of pieces of evidence has suggested that obesity is associated with a significant increase in the risk for gastroesophageal reflux disease (GERD) symptoms and its complications. The aim of this study was to evaluate the effect of weight loss on reflux symptoms in overweight/obese patients with proven GERD. We enrolled overweight/obese patients with typical GERD symptoms and erosive esophagitis. At baseline, patients underwent detailed reflux symptoms evaluation and anthropometric assessment, and were divided into two treatment groups: group A received proton pump inhibitor (PPI) and a personalized hypocaloric diet and aerobic exercise; and group B received PPI and a 'standard of care diet'. The dietetic treatment was considered effective if at least 10% of weight loss was achieved within 6 months. All patients were evaluated in terms of anthropometric data, GERD symptoms, and PPI use. In group A, mean body mass index (BMI) decreased from 30.3 ± 4.1 to 25.7 ± 3.1 (P < 0.05), and mean weight decreased from 82.1 ± 16.9 kg to 69.9 ± 14.4 kg (P < 0.05). In group B, there was no change in BMI and weight. Symptom perception decreased (P < 0.05) in both groups during PPI therapy, but a higher improvement was recorded in group A. In group A, PPI therapy was completely discontinued in 27/50 of the patients, and halved in 16/50. Only 7/50 continued the same PPI dosage. In group B, 22/51 halved the therapy and 29/51 maintained full dosage of therapy, but none was able to discontinue PPI due to a symptom recurrence. Overall, weight loss of at least 10% is recommended in all patients with GERD in order to boost the effect of PPI on reflux symptom relief and to reduce chronic medication use.

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

“…Weight loss appears to be another strategy in obese/overweight patients. Indeed, in one study, up to 54 % of subjects compliant to a hypocaloric diet were able to stop PPI therapy, with an additional 32 % being able to halve the dose [84]. All the above attempts should be considered also in patients who are already on long-term acid suppression.…”

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

“…It has been recognized as a significant public health concern in the West[1,2]. Usually, the major part of patients with mild GERD are treated effectively with dietary and lifestyle changes, and/or low-dosage proton pump inhibitors (PPIs)[3]. For patients with GERD refractory to PPIs, different treatments can be started.…”

Weight Loss Is Truly Effective in Reducing Symptoms and Proton Pump Inhibitor Use in Patients With Gastroesophageal Reflux Disease

“…In particular, the relevance of weight loss in overweight/obese patients with reflux symptoms is controversial, although the role of BMI as risk factor for GERD has been highlighted in several papers and reviews [2][3][4] . If the available studies in literature have been quoted since we recently published data from a comparative, prospective, nonrandomized study analyzing the efficacy of a hypocaloric diet and physical exercise versus a 'standard of care' dietetic program without any change in daily caloric intake, in patients with reflux symptoms and an endoscopically proven erosive esophagitis 5 . We showed that weight loss, obtained through a tailored dietetic program and increased aerobic exercise (101 patients enrolled), was: (i) associated with reduction of BMI, and waist and hip circumference; (ii) associated with higher reduction of GERD-related typical symptoms; and (iii) able to obtain a reduction/discontinuation of PPI dosage.…”

“…We showed that weight loss, obtained through a tailored dietetic program and increased aerobic exercise (101 patients enrolled), was: (i) associated with reduction of BMI, and waist and hip circumference; (ii) associated with higher reduction of GERD-related typical symptoms; and (iii) able to obtain a reduction/discontinuation of PPI dosage. 5 Demonstrating that reducing weight loss leads patients with GERD to reduce medication intake, we speculated that this kind of intervention may further drive to reduce the National Health System costs as a direct consequence. 5 In summary, our data confirm that lifestyle interventions and in particular 10% weight loss weight loss is truly effective in reducing symptoms and PPI use in patients with GERD.…”

“…5 Demonstrating that reducing weight loss leads patients with GERD to reduce medication intake, we speculated that this kind of intervention may further drive to reduce the National Health System costs as a direct consequence. 5 In summary, our data confirm that lifestyle interventions and in particular 10% weight loss weight loss is truly effective in reducing symptoms and PPI use in patients with GERD. This M A N U S C R I P T…”