Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations

• Published in: Obesity reviews Vol. 3; no. 1; pp. 9 - 15
• Main Authors: Barak, N., Ehrenpreis, E. D., Harrison, J. R., Sitrin, M. D>
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Science Asia Pty. Ltd 01-02-2002
• Subjects: Body Composition; Carcinoma - epidemiology; Carcinoma - etiology; Cimetidine - therapeutic use; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - etiology; Gastro-oesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - physiopathology; Hernia, Hiatal - complications; Histamine H2 Antagonists - pharmacokinetics; Histamine H2 Antagonists - therapeutic use; Humans; obesity; Obesity - complications; Obesity - physiopathology; Obesity - surgery; Pharmacokinetics; pharmacology; Pressure; Prevalence; Ranitidine - therapeutic use
• ISSN: 1467-7881; 1467-789X
• DOI: 10.1046/j.1467-789X.2002.00049.x

Summary
Gastro‐oesophageal reflux disease (GERD) is common in obese patients. Apart from the physical discomfort and the economic burden, GERD may increase morbidity and mortality through its association with oesophageal carcinoma. The pathophysiology of GERD differs between obese and lean subjects. First, obese subjects are more sensitive to the presence of acid in the oesophagus. Second, hiatal hernia, capable of promoting GERD by several mechanisms, is more prevalent among the obese. Third, obese subjects have increased intra‐abdominal pressure that displaces the lower oesophageal sphincter and increases the gastro‐oesophageal gradient. Finally, vagal abnormalities associated with obesity may cause a higher output of bile and pancreatic enzymes, which makes the refluxate more toxic to the oesophageal mucosa. The altered body composition associated with obesity affects the pharmacokinetics of drugs. There are no data regarding the efficacy of any of the drugs used for GERD treatment. The dosages of cimetidine and ranitidine should be calculated according to the patient’s ideal body weight, not their actual weight. Of the operative procedures used for weight loss, Roux‐en‐Y gastric bypass was found to be most effective for GERD, while gastric banding was associated with a high prevalence of reflux. This review outlines the pathophysiology and the treatment of GERD in obesity with emphasis on the therapeutic considerations in this population of patients.