Body mass index and GERD: Is the association that huge?
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Corresponding author Douglas Corley, MD, PhD Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA. E-mail: [email protected] Current GERD Reports 2007, 1:205–211 Current Medicine Group LLC ISSN 1934-967X Copyright © 2007 by Current Medicine Group LLC
Body mass has been proposed as a modifiable risk factor for gastroesophageal reflux disease (GERD). Although this association makes intuitive sense, study results conflict. This article critically reviews the epidemiologic and mechanistic data surrounding the relationship between body mass index (BMI) and GERD, evaluates how the relationship may depend upon abdominal size, and explores potential alternative mechanisms through which body mass may influence the risk of GERD complications.
Introduction Gastroesophageal reflux disease (GERD), a condition typified by symptoms of heartburn, acid regurgitation, or mucosal damage, is one of the most common, morbid, and costly medical conditions in the United States [1]. Surveys of the general public indicate that 10% to 20% of the population have GERD symptoms [2– 4]. GERD is also associated with several different morbidities, including esophagitis, esophageal strictures, and esophageal adenocarcinoma [3,5–14]. Because of the substantial health burden and expense imposed by GERD, much effort has focused on identifying nonpharmacologic methods of decreasing disease prevalence, but (unlike other disorders such as cardiovascular disease) there is relatively little evidence as to why only certain people develop the structural and functional conditions that cause GERD. One avenue of research has looked into the association between GERD and obesity, the prevalence of which has increased markedly in recent decades [15]. Although body mass index (BMI) and GERD are commonly believed to be strongly associated, how robust is the association between body mass and GERD?
What Is the Evidence? Several studies have suggested an association between body mass and the risk of GERD, but the results have been inconsistent, with well-designed studies showing no association [16–27]. Two recent systematic reviews with meta-analyses summarized the data for the associations between body mass and GERD (including GERD symptoms and GERD-related complications such as esophagitis). The first meta-analysis identified nine studies that evaluated the association between BMI and GERD symptoms using MEDLINE; the authors noted that only three studies were designed specifically to evaluate the association between body mass and GERD [28••]. Of the nine studies, six found significant associations between BMI and GERD symptoms and three found no association. The authors then identified an additional seven studies that evaluated the associations between BMI and erosive esophagitis, of which three were originally designed to analyze this association. Five of these studies found a significant association, and two found no definitive association. A second meta-analysis identified studies using MEDLINE and three additional sources: the Web of S
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