Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3030-3034
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3030
Gastroesophageal reflux in asymptomatic obese subjects: An esophageal impedance-pH study
Filiz Akyüz, Ahmet Uyanıkoglu, Fatih Ermis, Serpil Arıcı, Ümit Akyüz, Bülent Baran, Binnur Pinarbasi, Nurdan Gul
Filiz Akyüz, Serpil Arıcı, Bülent Baran, Binnur Pinarbasi, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey
Ahmet Uyanıkoglu, Divison of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Harran University, 63300 Urfa, Turkey
Fatih Ermis, Divison of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Duzce University, 81010 Duzce, Turkey
Ümit Akyüz, Divison of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Yeditepe University, 34858 Istanbul, Turkey
Nurdan Gul, Division of Endocrinology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey
Author contributions: Akyüz F, Uyanıkoglu A and Ermis F designed research and wrote the paper; Akyüz U, Baran B, Pinarbasi B and Gul N were responsible for the data collection and analysis; Arıcı S performed the impedance and manometry.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Filiz Akyüz, Professor, Division of Gastroenterohepatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Bahçeköy/İstanbul-Avrupa, 34390 Istanbul, Turkey. filizakyuz@hotmail.com
Telephone: +90-212-4142000-31140 Fax: +90-212-6319743
Received: April 27, 2014
Peer-review started: April 29, 2014
First decision: May 29, 2014
Revised: August 6, 2014
Accepted: November 8, 2014
Article in press: November 11, 2014
Published online: March 14, 2015
Processing time: 322 Days and 21.6 Hours
Abstract

AIM: To investigate the relationship between reflux and body mass index (BMI) in the asymptomatic obese population using the impedance-pH technique.

METHODS: Gastroesophageal reflux is frequent in the obese population. However, the relationship between acid reflux and BMI in asymptomatic obese people is unclear. Forty-six obese (BMI > 25 kg/m2) people were enrolled in this prospective study. We evaluated the demographic findings and 24-h impedance pH values of the whole group. Gas, acid (pH < 4), weak acid (pH = 4-7) and weak alkaline (pH ≥ 7) reflux parameters were analyzed.

RESULTS: The mean age of patients was 49.47 ± 12.24 years, and half of them were men. The mean BMI was 30.64 ± 3.95 kg/m2 (25.14-45.58 kg/m2). BMI of 23 was over 30 kg/m2. Seventeen patients had a comorbidity (hypertension, diabetes mellitus, or ischemic heart disease). Endoscopic examination revealed esophagitis in 13 of the 28 subjects (10 Grade A, 3 Grade B). The subjects were divided into two groups according to BMI (< 30 and > 30 kg/m2). Demographic and endoscopic findings, and impedance results were similar in these two groups. However, there was a positive correlation between BMI and total and supine pH < 4 episodes (P = 0.002, r = 0.414; P = 0.000, r = 0.542), pH < 4 reflux time (P = 0.015, r = 0.319; P = 0.003, r = 0.403), and DeMeester score (P = 0.012, r = 0.333).

CONCLUSION: Acid reflux is correlated with BMI in asymptomatic obese individuals.

Keywords: Reflux; Impedance; Obesity; 24-h pH-metry; Body mass index

Core tip: Obesity is an increasing problem worldwide. Few studies have reported on the association between gastroesophageal reflux symptoms and body mass index (BMI). We aimed to determine the effects of BMI on gastroesophageal reflux using esophageal pH-impedance technique in asymptomatic overweight and obese subjects. We found that BMI is positively correlated with acid reflux. Our study demonstrated that obesity is a risk factor for gastroesophageal reflux even in an asymptomatic healthy individuals. These findings are important for the obese population who are referred for bariatric surgery. Gastroesophageal reflux should be evaluated carefully before surgery, even in the absence of symptoms.