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Waist circumference linked to esophageal dysfunction, reflux symptoms
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Abdominal obesity increased the risk for symptoms of acid reflux and esophageal dysfunction, but was not associated with increased acid exposure, according to recent study results.
Researchers measured the height, weight and waist circumference (WC) of 582 patients (median age, 48 years; 56% female) with suspected GERD related to reflux symptoms. Esophageal motility and the esophago-gastric junction (EGJ) were assessed via manometry, and participants also underwent 24-hour ambulatory esophageal pH monitoring. Most participants (n=406) also completed a questionnaire on symptom severity.
Abdominal obesity (WC of 99 cm or more) was more common among males (41% vs. 28%, P=.001), while general obesity (BMI of 30 kg/m2 or greater) was more frequent in females (23% vs. 16%, P=.056).
Exposure to esophageal acid increased with abdominal obesity (R=0.284) and BMI (R=0.236) (P<.001 for both). Adjustment for age and sex reduced these associations (R=0.189 for WC and R=0.211 for BMI, P<.001 for both), as did adjustment for lower esophageal sphincter (LOS) pressure, intra-abdominal LOS length and distal contractile amplitude (P<.001 for both).
LOS pressure, peristaltic dysfunction and shorter length of abdominal LOS also were associated with acid exposure (P<.001 for all). LOS pressure (R=–0.136; P=.001), but not length (R=–0.095; P=.055), was negatively associated with BMI, while there was a negative association between LOS pressure (R=–0.221) and length (R=–0.209) with WC.
Multivariate analysis adjusting for age, sex and esophageal acid exposure indicated no significant associations between symptom severity and either BMI (P=.605) or WC (P=.32).
“The results confirm that abdominal obesity (WC) impacts on the integrity of the [EGJ] reflux barrier,” the researchers concluded. “However, these effects did not explain the increase in acid exposure seen in obese patients. … Definitive evidence to confirm or refute that the link between obesity and GERD is driven by mechanical factors or mediators released from visceral adipose tissue will require long-term follow-up and repeated investigation of a large, population-based cohort over time.”
Disclosure: See the study for a full list of relevant disclosures.
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