GERD and Obesity

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease (GERD) is a common condition where stomach acid flows back into the food pipe, causing symptoms like heartburn and chest pain. 

Obesity is when someone has too much body fat, which can harm their health. GERD affects many people, up to 40%, while obesity is a widespread issue worldwide.

GERD and obesity are closely linked. Being overweight increases the risk of developing and worsening GERD symptoms. People with obesity often have more severe acid reflux, which can lead to serious problems like Barrett’s esophagus and cancer. 

Relation of Obesity and GERD

Obesity plays a significant role in exacerbating the severity of GERD symptoms and increasing the risk of developing them. Studies indicate that individuals with higher BMIs experience more severe symptoms of GERD, with a notable increase in frequency and intensity, particularly in those with BMIs greater than 30 kg/m². 

Moreover, there’s a clear association between obesity and the development of erosive esophagitis, with individuals having a BMI over 35 kg/m² being at a significantly higher risk. 

Postmenopausal hormone therapy further complicates this relationship, as it appears to augment the association between obesity and GERD symptoms, particularly in women. This suggests a complex interplay between hormonal factors and obesity in exacerbating GERD symptoms. 

Therefore, managing obesity becomes crucial not only for general health but also for mitigating the severity of GERD and related complications.

Management Strategies For GERD In Obese Patients

Traditionally, when it comes to dealing with acid reflux, doctors have mostly focused on treating the symptoms directly instead of looking at the root causes. 

They usually start by suggesting simple lifestyle changes like raising the head of your bed, cutting out things like caffeine and chocolate from your diet, and using medications called proton pump inhibitors. 

 Lifestyle changes, including weight loss, are also recommended. Surgical intervention is considered for patients with refractory symptoms or quality of life issues, particularly those who fail to respond to medical management.

Does it Affect Weight and Lead to Weight Loss?

Yes, the body is significantly affected, and weight loss occurs. However, if you notice a decrease in weight, it is essential to consult your specialist doctor because it becomes unhealthy weight loss, which affects the rest of the body’s organs.

Symptoms Observed in a Patient with GERD:

– Difficulty swallowing.

– Frequent vomiting.

– Feeling full quickly.

– Loss of appetite.

– Burning sensation in the middle of the chest.

– Sore throat.

All these symptoms lead to significant weight loss, but it is a pathological weight loss that needs treatment.

How is it Diagnosed?

Diagnostic tests commonly used to confirm GERD include:

1- Upper Endoscopy (Esophagogastroduodenoscopy or EGD): A flexible tube with a camera at the end is inserted through the mouth and into the Esophagus, stomach, and part of the small intestine. This allows the doctor to visually inspect the Esophagus for signs of inflammation, irritation, or damage caused by acid reflux.

2- Esophageal pH Monitoring: This test measures the level of acid in the eEsophagus over a 24-hour period. A thin tube is inserted through the nose into the Esophagus, and the patient wears a small device that records pH levels. It helps determine the frequency and severity of acid reflux episodes.

3- Esophageal Manometry: This test measures the strength and coordination of the muscles in the Esophagus. It involves passing a thin tube through the nose and into the Esophagus to measure pressure and muscle contractions while swallowing.

4- Barium Swallow X-ray: The patient drinks a chalky liquid containing barium, which coats the Esophagus, stomach, and upper part of the small intestine. X-rays are then taken to detect abnormalities in the Esophagus or stomach.

How to prevent GERD?

– Maintain a healthy weight.

– Watch your diet and avoid trigger foods.

– Eat smaller meals and avoid eating before bed.

– Elevate the head of your bed.

Obesity Surgeries And GERD

Bariatric surgery for GERD patients requires meeting NIH criteria, including a BMI over 40 kg/m² or over 35 kg/m² with significant comorbidities, alongside documented weight loss attempts and no untreated psychopathology. Procedures aim to induce weight loss, altering intra-abdominal pressure and potentially reducing GERD symptoms. Gastric restrictive procedures like vertical banded gastroplasty (VBG) may not effectively alleviate GERD, while esophagogastric banding outcomes vary. However, reports indicate significant improvement in GERD symptoms following Roux-en-Y gastric bypass (RYGBP), with some studies showing resolution in a substantial percentage of patients. These findings suggest RYGBP’s potential as an effective treatment option for GERD in morbidly obese individuals, emphasizing the importance of considering bariatric surgery in managing GERD.

Conclusion

At Cosmesurge Hospitals across the UAE, Dr. Samir offers various bariatric surgeries for GERD and related issues. We follow strict guidelines to ensure effective treatment. Our procedures, like vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP), focus on weight loss and reducing GERD symptoms.