The Association Between Obesity and Gerd: A Review of The Epidemiological Evidence
Keywords:
gastroesophageal reflux disease, gastroesophageal reflux disease, obesity, obesity, body mass index, body mass index, epidemiology, epidemiology, meta-analysis, meta-analysisAbstract
Background: Gastroesophageal reflux disease (GERD) and obesity have both reached epidemic proportions globally, with mounting evidence suggesting a strong association between these conditions.
Objective: To systematically review and synthesize epidemiological evidence examining the relationship between obesity and GERD, including its complications such as erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma.
Methods: A comprehensive review of epidemiological studies, meta-analyses, and systematic reviews was conducted, focusing on population-based studies, cohort studies, and case-control studies that examined the association between various measures of obesity and GERD-related outcomes.
Results: Strong epidemiological evidence demonstrates a consistent positive association between obesity and GERD. Meta-analyses show that overweight individuals (BMI 25-30 kg/m²) have a 1.4-1.6-fold increased risk of GERD symptoms, while obese individuals (BMI ≥30 kg/m²) have a 1.9-2.9-fold increased risk. The relationship exhibits a clear dose-response pattern, with risk increasing progressively across BMI categories, even within the normal weight range. Abdominal obesity, particularly visceral fat accumulation, appears to be a stronger predictor of GERD complications than overall BMI. Weight loss interventions consistently demonstrate improvement in GERD symptoms, with structured programs achieving complete symptom resolution in 65% of participants.
Conclusions: The epidemiological evidence overwhelmingly supports a causal relationship between obesity and GERD. The association is consistent across diverse populations, demonstrates biological plausibility through multiple mechanisms, and shows reversibility with weight loss interventions.
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Corley, D. A., & Kubo, A. (2006). Body mass index and gastroesophageal reflux disease: A systematic review and meta-analysis. American Journal of Gastroenterology, 101(11), 2619-2628. https://doi.org/10.1111/j.1572-0241.2006.00849.x
El-Serag, H. B. (2008). The association between obesity and GERD: A review of the epidemiological evidence. Digestive Diseases and Sciences, 53(9), 2307-2312. https://doi.org/10.1007/s10620-008-0413-9
Ohashi, S., Maruno, T., Fukuyama, K., Kikuchi, O., Sunami, T., Kondo, Y., Imai, S., Matsushima, A., Suzuki, K., Usui, F., Yakami, M., Yamada, A., Isoda, H., Matsumoto, S., Seno, H., Muto, M., & Inoue, M. (2021). Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40-69-years subjects. Esophagus, 18(4), 889-899. https://doi.org/10.1007/s10388-021-00859-5
Hampel, H., Abraham, N. S., & El-Serag, H. B. (2005). Meta-analysis: Obesity and the risk for gastroesophageal reflux disease and its complications. Annals of Internal Medicine, 143(3), 199-211. https://doi.org/10.7326/0003-4819-143-3-200508020-00006
Singh, M., Lee, J., Gupta, N., Gaddam, S., Smith, B. K., Wani, S. B., Sullivan, D. K., Rastogi, A., & Bansal, A. (2013). Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial. Obesity, 21(2), 284-290. https://doi.org/10.1002/oby.20006
Jacobson, B. C., Somers, S. C., Fuchs, C. S., Kelly, C. P., & Camargo, C. A. (2006). Body-mass index and symptoms of gastroesophageal reflux in women. New England Journal of Medicine, 354(22), 2340-2348. https://doi.org/10.1056/NEJMoa054391
Corley, D. A., Kubo, A., & Zhao, W. (2007). Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut, 56(6), 756-762. https://doi.org/10.1136/gut.2006.109413
Yamasaki, T., Hemond, C., Eisa, M., Ganocy, S., & Fass, R. (2020). The changing epidemiology of gastroesophageal reflux disease: Are patients getting younger? Journal of Neurogastroenterology and Motility, 26(4), 467-475. https://doi.org/10.5056/jnm20036
Koppman, J. S., Poggi, L., Szomstein, S., Ukleja, A., Botoman, A., & Rosenthal, R. (2007). Esophageal motility disorders in the morbidly obese population. Surgery for Obesity and Related Diseases, 3(3), 291-296. https://doi.org/10.1016/j.soard.2006.12.004
Pandolfino, J. E., El-Serag, H. B., Zhang, Q., Shah, N., Ghosh, S. K., & Kahrilas, P. J. (2006). Obesity: A challenge to esophagogastric junction integrity. Gastroenterology, 130(3), 639-649. https://doi.org/10.1053/j.gastro.2005.12.016
Ryan, A. M., Duong, M., Healy, L., Ryan, S. A., Parekh, N., Reynolds, J. V., & Power, D. G. (2011). Obesity, metabolic syndrome and esophageal adenocarcinoma: Epidemiology, etiology and new targets. Cancer Epidemiology, 35(4), 309-319. https://doi.org/10.1016/j.canep.2011.03.001
Hoyo, C., Cook, M. B., Kamangar, F., Freedman, N. D., Whiteman, D. C., Bernstein, L., Brown, L. M., Risch, H. A., Ye, W., Sharp, L., Wu, A. H., Ward, M. H., Casson, A. G., Murray, L. J., Corley, D. A., Nyren, O., Pandeya, N., Vaughan, T. L., Chow, W. H., & Gammon, M. D. (2012). Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: A pooled analysis from the International BEACON Consortium. International Journal of Epidemiology, 41(6), 1706-1718. https://doi.org/10.1093/ije/dys176
Hveem, K., Oberle, C., Straume, B., Svensson, E., Lind, T., Bytzer, P., & Johnsen, R. (2004). Proton pump inhibitors: Population tolerability and non-cardiac chest pain. Alimentary Pharmacology & Therapeutics, 20(11-12), 1385-1392. https://doi.org/10.1111/j.1365-2036.2004.02302.x
Lim, S. L., Canavarro, C., Zaw, M. H., Zhu, F., Loke, W. C., Chan, Y. H., Yeoh, K. G., & Lim, W. C. (2016). Sex and gender differences in gastroesophageal reflux disease. Journal of Neurogastroenterology and Motility, 22(4), 655-662. https://doi.org/10.5056/jnm16138
Ayazi, S., Hagen, J. A., Chan, L. S., DeMeester, S. R., Lin, M. W., Ayazi, A., Leers, J. M., Oezcelik, A., Banki, F., Lipham, J. C., DeMeester, T. R., & Crookes, P. F. (2009). Obesity and gastroesophageal reflux: Quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. Journal of Gastrointestinal Surgery, 13(8), 1440-1447. https://doi.org/10.1007/s11605-009-0930-7
El-Serag, H. B., Ergun, G. A., Pandolfino, J., Fitzgerald, S., Tran, T., & Kramer, J. R. (2007). Obesity increases oesophageal acid exposure. Gut, 56(6), 749-755. https://doi.org/10.1136/gut.2006.100263
Friedenberg, F. K., Xanthopoulos, M., Foster, G. D., & Richter, J. E. (2008). The association between gastroesophageal reflux disease and obesity. American Journal of Gastroenterology, 103(8), 2111-2122. https://doi.org/10.1111/j.1572-0241.2008.01946.x
Kubo, A., & Corley, D. A. (2021). Excess body weight and gastroesophageal reflux disease. Visceral Medicine, 37(4), 267-272. https://doi.org/10.1159/000515451
Lee, H. L., Eun, C. S., Lee, O. Y., Jeon, Y. C., Han, D. S., Yoon, B. C., Choi, H. S., Hahm, J. S., & Lee, M. H. (2015). The effect of abdominal visceral fat, circulating inflammatory cytokines, and leptin levels on reflux esophagitis. Journal of Neurogastroenterology and Motility, 21(2), 247-254. https://doi.org/10.5056/jnm14114
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