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http://dx.doi.org/10.5009/gnl18148

Weight Loss as a Nonpharmacologic Strategy for Erosive Esophagitis: A 5-Year Follow-up Study  

Bang, Ki Bae (Department of Internal Medicine, Dankook University College of Medicine)
Park, Jung Ho (Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
Publication Information
Gut and Liver / v.12, no.6, 2018 , pp. 633-640 More about this Journal
Abstract
Background/Aims: Obesity is a risk factor for gastroesophageal reflux disease (GERD), with several studies demonstrating positive associations between body mass index (BMI) and GERD symptoms. However, little is known about the effect of BMI changes on erosive esophagitis (EE). In this study, we investigated whether BMI reduction could resolve EE. Methods: A retrospective cohort study was performed to assess the natural course of EE according to changes in BMI. Participants undergoing health check-ups from 2006 to 2012 were enrolled, and 1,126 subjects with EE were included. The degree of esophagitis was measured by upper endoscopy and serially checked over a 5-year follow-up. Logistic regression and Cox proportional hazards models were used to investigate the association between BMI reduction and EE resolution. Results: Substantial weight loss is associated with EE resolution. The adjusted odds ratio for EE resolution was 1.44 (95% confidence interval [CI], 1.09 to 1.92) among participants with a decrease in BMI compared to those with no decrease in BMI. The EE resolution rate was related to the degree of BMI reduction. The effect of weight loss on EE resolution was higher among subjects who lost more weight. Compared with subjects with no decrease in BMI, the hazard ratios for EE resolution were 1.09 (95% CI, 0.89 to 1.35), 1.31 (95% CI, 1.01 to 1.72) and 2.12 (95% CI, 1.44 to 3.12) in subjects with BMI reductions of ${\leq}1$, 1-2, and >$2kg/m^2$, respectively. Conclusions: EE resolution is associated with a decrease in BMI, and weight loss is potentially an effective GERD treatment.
Keywords
Gastroesophageal reflux; Body mass index; Erosive esophagitis; Weight loss;
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1 Park SK, Lee T, Yang HJ, et al. Weight loss and waist reduction is associated with improvement in gastroesophageal disease reflux symptoms: a longitudinal study of 15 295 subjects undergoing health checkups. Neurogastroenterol Motil 2017;29:e13009.   DOI
2 Labenz J, Nocon M, Lind T, et al. Prospective follow-up data from the ProGERD study suggest that GERD is not a categorial disease. Am J Gastroenterol 2006;101:2457-2462.   DOI
3 Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-1920.   DOI
4 Harvey RF, Gordon PC, Hadley N, et al. Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis. Lancet 1987;2:1200-1203.
5 Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Tobacco smoking cessation and improved gastroesophageal reflux: a prospective population-based cohort study: the HUNT study. Am J Gastroenterol 2014;109:171-177.   DOI
6 Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol 2006;101:2619-2628.   DOI
7 Eslick GD. Gastrointestinal symptoms and obesity: a meta-analysis. Obes Rev 2012;13:469-479.   DOI
8 El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 2005;100:1243-1250.   DOI
9 Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 2006;354:2340-2348.   DOI
10 Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005;143:199-211.   DOI
11 Kang MS, Park DI, Oh SY, et al. Abdominal obesity is an independent risk factor for erosive esophagitis in a Korean population. J Gastroenterol Hepatol 2007;22:1656-1661.   DOI
12 Lee HL, Eun CS, Lee OY, et al. Association between GERD-related erosive esophagitis and obesity. J Clin Gastroenterol 2008;42:672-675.   DOI
13 Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology 2008;135:1383-1391.   DOI
14 Park JH, Park DI, Kim HJ, et al. Metabolic syndrome is associated with erosive esophagitis. World J Gastroenterol 2008;14:5442-5447.   DOI
15 Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179-1187.e3.   DOI
16 Vaezi MF, Yang YX, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology 2017;153:35-48.   DOI
17 Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-1645.   DOI
18 Hamaguchi M, Kojima T, Itoh Y, et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol 2007;102:2708-2715.   DOI
19 Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996;111:85-92.   DOI
20 Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 2006;130:639-649.   DOI
21 El-Serag HB, Tran T, Richardson P, Ergun G. Anthropometric correlates of intragastric pressure. Scand J Gastroenterol 2006;41:887-891.   DOI
22 Cai N, Ji GZ, Fan ZN, et al. Association between body mass index and erosive esophagitis: a meta-analysis. World J Gastroenterol 2012;18:2545-2553.   DOI
23 Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: a systematic review. J Neurogastroenterol Motil 2011;17:14-27.   DOI
24 Francis DO, Rymer JA, Slaughter JC, et al. High economic burden of caring for patients with suspected extraesophageal reflux. Am J Gastroenterol 2013;108:905-911.   DOI
25 Shaheen N, Ransohoff DF. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. JAMA 2002;287:1972-1981.   DOI
26 Sharma P, Wani S, Romero Y, Johnson D, Hamilton F. Racial and geographic issues in gastroesophageal reflux disease. Am J Gastroenterol 2008;103:2669-2680.   DOI
27 Goh KL. Gastroesophageal reflux disease in Asia: a historical perspective and present challenges. J Gastroenterol Hepatol 2011;26 Suppl 1:2-10.
28 El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63:871-880.   DOI
29 Ronkainen J, Agreus L. Epidemiology of reflux symptoms and GORD. Best Pract Res Clin Gastroenterol 2013;27:325-337.   DOI
30 Kang JH, Kang JY. Lifestyle measures in the management of gastro-oesophageal reflux disease: clinical and pathophysiological considerations. Ther Adv Chronic Dis 2015;6:51-64.   DOI
31 Tilg H, Moschen AR. Visceral adipose tissue attacks beyond the liver: esophagogastric junction as a new target. Gastroenterology 2010;139:1823-1826.   DOI
32 Jung HS, Choi MG, Baeg MK, et al. Obesity is associated with increasing esophageal acid exposure in Korean patients with gastroesophageal reflux disease symptoms. J Neurogastroenterol Motil 2013;19:338-343.   DOI
33 Kouklakis G, Moschos J, Kountouras J, Mpoumponaris A, Molyvas E, Minopoulos G. Relationship between obesity and gastroesophageal reflux disease as recorded by 3-hour esophageal pH monitoring. Rom J Gastroenterol 2005;14:117-121.
34 Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology 2007;132:883-889.   DOI
35 Kjellin A, Ramel S, Rossner S, Thor K. Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 1996;31:1047-1051.   DOI
36 Cremonini F, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. Relationship between upper gastrointestinal symptoms and changes in body weight in a population-based cohort. Neurogastroenterol Motil 2006;18:987-994.   DOI
37 Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Weight loss and reduction in gastroesophageal reflux. A prospective population- based cohort study: the HUNT study. Am J Gastroenterol 2013;108:376-382.   DOI
38 Singh M, Lee J, Gupta N, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring) 2013;21:284-290.   DOI