Gastroesophageal Reflux Disease in Obese Patients: Clinical, Functional, and Morphological Features
Study Objective: To study the clinical, functional and morphological features of gastroesophageal reflux disease (GERD) in patients with abdominal obesity and in non-obese subjects, and evaluate approaches to treating GERD in obese patients. Study Design: This was a comparative study. Materials and Methods: Seventy-five patients with GERD and abdominal obesity (main group) and 56 non-obese patients with GERD (control group) were examined. The following data were assessed in all the patients: clinical data, X-ray, esophageal manometry and 24-hour pH monitoring, and esophago-gastroduodenoscopy findings, as well as the results of histological examination of the esophageal mucosa. Study Results: Patients in the main group had atypical GERD: heartburn was not the main complaint; the predominant clinical symptoms were those caused by disturbances in gastric and esophageal motility; and histological examination of the esophageal mucosa showed no dilation of intercellular spaces, expansion of the basal layer of the stratified squamous esophageal epithelium, or inflammatory infiltration of the lamina propria. Given the specific features found in patients with abdominal obesity, GERD management for these patients should include weight loss and intake of prokinetic agents. In cases of alkaline reflux, ursodeoxycholic acid is justified. In cases of acid reflux, proton-pump inhibitors are the medications of choice. Conclusion: In patients with abdominal obesity, the clinical manifestations and progression of GERD have several specific features, which should be considered when prescribing treatment.