In their meta-analysis -- a review of several studies -- the investigators found that excess weight nearly doubled the risk of GERD symptoms such as heartburn, acid regurgitation, chest pain and difficulty swallowing.

People who were obese, defined as a body mass index (BMI) greater than 30, were nearly three times more likely to develop esophageal cancer than those with a healthy body weight. BMI is a measure of a person's weight in relation to their height.

GERD occurs when the valve between the stomach and the esophagus fails to close properly. As a result, the contents in the stomach, including stomach acid, can spill up into the esophagus, leading to erosion of the esophagus and, in some cases, esophageal cancer.

The results of the study in the Aug. 2 issue of the Annals of Internal Medicine point to a way to prevent and treat both GERD and its associated complications, said Dr. Hashem B. El-Serag, a study author. He added that an important next step will be to investigate whether weight loss actually improves GERD symptoms and complications.

"There is credible evidence to incriminate obesity in yet another set of diseases. Although there is little information on whether losing weight will reverse the risk of these complications, it is very likely that staying [at a] normal weight helps reduce the risk of GERD and its complications."

Dr. David A. Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School, agreed, noting that weight loss has been shown to improve a number of other medical problems.

"The causal relationship is there and it would be suggestive that reduction in obesity and overweight status would be helpful for lots of reasons," he said.

The new study findings come in the context of a steady rise in both obesity and the complications of GERD in the United States and Western Europe. Nearly two-thirds of American adults are overweight, according to the U.S. Centers for Disease Control and Prevention.

At the same time, the rate of esophageal adenocarcinoma has quadrupled in the past 20 years with an estimated 20 percent of U.S. adults suffering from GERD, the study authors report.

But exactly how excess body weight increases GERD symptoms and complications remains unclear. One possibility is that too much weight in the abdomen compresses the stomach and raises the pressure inside, leading to gastric reflux.

Alternately, abdominal obesity can contribute to the release of inflammatory substances that may raise the risk of GERD. Thirdly, many people who are obese eat excessive amounts of fat and fatty foods can increase the risk of GERD, explained El-Serag, assistant professor of medicine at Baylor College of Medicine in Houston.

The study results are based on an analysis of nine studies conducted over 18 years. People who were overweight, defined by a body mass index of 25 to 30, were 1.4 times as likely to develop GERD symptoms, while people who were obese were nearly twice as likely to develop symptoms compared to those with a healthy body weight.

The study "adds another reason for patients to remain a healthy weight," El-Serag said. "This can help them avoid GERD with its associated nuisance, treatment, and potential complications, including cancer of the esophagus."

Reference Source 101
August 2, 2005

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