Association of Obesity With Hiatal Hernia and Esophagitis

Wilson, Louis; Ma, Wenzhou; Hirschowitz, Basil I.

doi:10.1111/j.1572-0241.1999.01426.x

Cited by 353 publications

(143 citation statements)

References 25 publications

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“…From an anatomic standpoint, obesity was also associated with increased axial separation between the LES and extrinsic crural diaphragm, an objective measure of the disruption of the esophagogastric junction (EGJ) culminating in the development of hiatal hernia. This confirms older studies where obesity was a significant independent risk factor for hiatal hernia, especially in whites [11]. Not to be forgotten in these mechanistic studies, a prospective study of 84 patients observed that obesity was associated with an increased frequency of transient lower esophageal sphincter relaxation and increased acid exposure [12].…”

supporting

confidence: 83%

Gastroesophageal Reflux Disease and Obesity: Not as Simple as We May Think

Richter

2012

Dig Dis Sci

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There is no doubt that, over the last 20 years, westernized countries are seeing a dramatic increase in obesity [1]. This comes at the same time that we are seeing the rates of H. pylori infection in these populations decreasing from 80 % to less than 20 % [2]. Therefore, healthy stomachs with more acid and the refluxogenic contributions of obesity are together leading to an epidemic of GERD and its complications. The epidemiologic data are conclusive that obesity increases the rates of reflux symptoms, frequency and severity of esophagitis, and the frequency of Barrett's esophagus and adenocarcinoma of the esophagus [3][4][5][6]. Recent studies are also suggesting that symptom relief from proton pump inhibitors (PPIs) is more difficult to obtain in the obese patient, with more failing ''on demand'' therapy and single dose PPIs [7,8]. Therefore, these patients may more frequently need to be on maintenance once or twice a day PPI regimens, possibly increasing the risk of long-term complications to this class of drugs.What are the physiologic mechanisms by which obesity contributes to GERD? Recent studies suggest that central or abdominal obesity, as measured by the waist-to-hip ratio, may be more important than general obesity as measured by the body mass index (BMI). For example, a large cross-sectional study of 80,111 individuals from the Kaiser Permanente health system found a significant relationship between increased abdominal diameter and reflux symptoms independent of BMI (OR 1.85, 95 % CI 1.55-2.21). Interestingly, this correlation was much more pronounced in the white population and in male subjects [9].In theory, central obesity should raise intragastric pressure, thereby predisposing to reflux. This was proven in a seminal study by Pandolfino et al.[10] where they studied 285 patients (81 overweight: BMI 25-30 kg/m 2 ; and 75 obese: BMI [ 30 kg/m 2 ) with high resolution manometry. They found that the pressure morphology within and across the esophagogastric junction is altered in obesity in a fashion that would promote the flow of gastric juices into the esophagus. Particularly, during the inspiratory phase of respiration, increased intragastric pressure and the gastroesophageal pressure gradient (GEPG) were strongly correlated with increased BMI. Both factors correlated even more strongly with waist circumference, suggesting that this is the mediator in the causal pathway of the BMI effect. There was a dose-dependent relationship such that the higher the BMI and waist circumference, the greater the intragastric pressure and GEPG. From an anatomic standpoint, obesity was also associated with increased axial separation between the LES and extrinsic crural diaphragm, an objective measure of the disruption of the esophagogastric junction (EGJ) culminating in the development of hiatal hernia. This confirms older studies where obesity was a significant independent risk factor for hiatal hernia, especially in whites [11]. Not to be forgotten in these mechanistic studies, a prospective study of 84 patients o...

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supporting

confidence: 83%

Gastroesophageal Reflux Disease and Obesity: Not as Simple as We May Think

Richter

2012

Dig Dis Sci

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“…High intra-abdominal pressure due to abdominal fat accumulation has been reported to result in an increased gastroesophageal pressure gradient and subsequently facilitate the development of hiatal hernia (10)(11)(12)(13)(14). Among the present male subjects, BMI and the prevalence of diaphragmatic hiatus increased in a concomitant manner during the study period.…”

Section: Discussionmentioning

confidence: 59%

“…GERD has been becoming more prevalent in Asian populations in recent decades, and although the disease is considered to be a common disorder in both Western and Asian populations, its increasing prevalence in Asia may be due to multiple factors, such as the Westernization of eating habits, decrease in the rate of Helicobacter pylori infection, increased gastric acid secretion and a larger elderly population, as well as other factors (2)(3)(4)(5)(6)(7)(8)(9). High intra-abdominal pressure caused by abdominal fat accumulation has been demonstrated to increase the gastroesophageal pressure gradient and incidence of gastroesophageal reflux, while obesity and a high body mass index (BMI) have repeatedly been reported to be correlated with a high prevalence of reflux esophagitis and symptoms of GERD (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). On the other hand, gender differences related to chronological changes in BMI and the prevalence of GERD have not been investigated in Japanese subjects, although a male predominance has been shown to be related to the frequency of reflux esophagitis and GERD (2-5, 8, 9).…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in the Time-Course Changes of Reflux Esophagitis in Japanese Patients

et al. 2015

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Objective Obesity is related to an increased prevalence of reflux esophagitis and gastroesophageal reflux disease symptoms. This study was performed to clarify the influence of gender on time-course changes in the rate of a high BMI and incidence of reflux esophagitis in Japanese subjects. Results A multiple logistic regression analysis showed that a high BMI, milder degree of gastric mucosal atrophy and larger size of diaphragmatic hiatus were significant predictive factors for the presence of reflux esophagitis in both men and women. The number of male subjects with reflux esophagitis and a high BMI increased during the 10-year examination period. In contrast, the number of individuals with reflux esophagitis and a high BMI was not increased among women. For both men and women, the proportions of patients with a large diaphragmatic hiatus and mild gastric mucosal atrophy increased during the 10-year period. Conclusion The prevalence of reflux esophagitis in the female subjects remained constant over 10 years, different from that observed in the men. A lack of change in BMI may be an important factor accounting for the constant prevalence of reflux esophagitis in women.

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“…Dietary fats and high caloric intake are associated with an increased risk of AC, while a protective role seem to be linked with high fiber diet, some vitamins, iron and zinc. 36 Obesity is a significant independent risk factor for hiatal hernia and is associated with esophagitis 37 and it is probably the greatest risk factor for AC 38 and the steadily increase of its prevalence parallels with the rise of esophageal and cardia AC.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for Barrett's esophagus: A case‐control study

Conio¹,

Filiberti²,

Blanchi³

et al. 2001

Intl Journal of Cancer

139

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Barrett's esophagus (BE) is an acquired disorder due to chronic gastroesophageal reflux. Environmental factors seem to play an important role in the pathogenesis of BE, especially in Western society. A multicenter case-control study was carried out between February 1995 and April 1999 in 8 Italian Departments of Gastroenterology gathered in a study group (GOSPE), in order to analyze the influence of some individual characteristics and life-style habits on the occurrence of BE. Three groups of patients were studied: 149 patients with BE, 143 patients with esophagitis (E) and 308 hospital controls (C) with acute, non-neoplastic, non-gastroenterological conditions. The diagnosis of BE was based on endoscopy and histology. E was defined by the Savary classification (grade I-III). Data collection was performed by using a questionnaire that focused on smoking, coffee and alcohol consumption, medical history, drugs history, gastroesophageal reflux disease (GERD) symptoms (heartburn, regurgitation) and socio-economic status. Multivariate analysis showed that the frequency of weekly GERD symptoms was significantly associated with both BE and E (p<0.0001), such as the presence of hiatal hernia (p<0.001). Ulcer was significantly associated with BE (p‫.)100.0؍‬ Among patients with E, the risk was directly related to spirits consumption (p‫.)30.0؍‬ Patients with GERD symptoms that lasted more than 13 years were more likely to have BE than E (p‫.)10.0؍‬ In conclusion, results from our study point out that long-standing GERD symptoms, hiatal hernia and possibly alcohol consumption are risk factors in the development of the BE and E.

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Association of Obesity With Hiatal Hernia and Esophagitis

Abstract: Excessive body weight is a significant independent risk factor for hiatal hernia and is significantly associated with esophagitis, largely through an increased incidence of hiatal hernia. Whites are more likely to have the combination of esophagitis and hiatal hernia than are blacks.

Cited by 353 publications

References 25 publications

Gastroesophageal Reflux Disease and Obesity: Not as Simple as We May Think

Gastroesophageal Reflux Disease and Obesity: Not as Simple as We May Think

Gender Differences in the Time-Course Changes of Reflux Esophagitis in Japanese Patients

Risk factors for Barrett's esophagus: A case‐control study

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