Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?

Abstract

Background/AimsTo evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure.MethodsWe conducted a cross-sectional study of 58 patients: 30 MO (cases) and 28 non-MO (controls). Esophageal symptoms and esophageal sensitivity to 0.1 M hydrochloric acid solution (Bernstein test) were compared between MO and non-MO patients with a prior diagnosis of abnormal esophageal acid exposure.ResultsMO patients were less symptomatic than non-MO controls (14% vs 96%; odds ratio [OR], 0.006; 95% confidence interval [CI], 0.001 to 0.075; p=0.000). MO patients were more likely to present with decreased esophageal sensitivity to the instillation of acid than non-MO controls (57% vs 14%; OR, 8; 95% CI, 1.79 to 35.74; p=0.009). Subgroup analysis revealed no differences in esophageal sensitivity in MO patients with and without abnormal esophageal acid exposure (43% vs 31%; p=0.707).ConclusionsSilent gastroesophageal reflux disease (GERD) is common among MO individuals, likely due to decreased esophageal sensitivity to acid. The absence of typical GERD symptoms in these patients may delay discovery of precancerous conditions, such as Barrett’s esophagus. We believe that these patients may require a more aggressive diagnostic work-up to rule out the presence of silent GERD.

Esophageal acid sensitivity in patients with gastroesophageal reflux disease: Does esophageal hypomotility matter?

“…Therefore, our findings might suggest that patients with higher BMI are characterized with less responsiveness to esophageal acid infusion, which would impact the perception of acid refluxate and consequently be an importantly pathogenic mechanism of obesity risking GERD. Our findings are in agreement with previous studies on reflux patients with morbidly obese (MO), which showed that patients with MO were less responsive to acid infusion and less symptomatic when compared with non‐MO controls . However, acid infusion we test may not be identically similar to a truly reflux event, which may consist other chemical components other than gastric acid.…”

“…Our findings are in agreement with previous studies on reflux patients with morbidly obese (MO), which showed that patients with MO were less responsive to acid infusion and less symptomatic when compared with non-MO controls. 22 However, acid infusion we test may not be identically similar to a truly reflux event, which may consist other chemical components other than gastric acid. Therefore, since obesity has been demonstrated to be a risk factor for GERD severity, 23 our data may provide additional pathophysiological evidence in the link between decreased acid sensitivity and increased BMI in patients with GERD.…”

Prevalence of gastroesophageal reflux disease in obese patients eligible for bariatric surgery

“…The occurrence of typical symptoms of GERD is highly variable in obese patients given that some studies found a positive correlation between symptoms and BMI, 17,18 whereas other studies found no such association. 12,19,20 GERD is a complex condition diagnosed with methods that use independent variables, leading to variability in the results, especially for typical symptoms, because this diagnosis involves personal, cultural, subjective, and psychological factors. However, the clinical characteristics of GERD and its connection with esophageal acid exposure were consistent with the results of studies conducted in other countries.…”

Editorial: giving high‐grade help to low‐grade dysplasia

“…One intriguing and further characteristic of this model should be noted—it does not include reflux symptoms. Oesophageal hyposensitivity has been noted for decades by in vivo experiments demonstrating relative insensitivity to acid perfusion and clinical data demonstrating an absence of heartburn in large number of patients with Barrett's . We feel that this theme of defining future screening and surveillance strategies for Barrett's and adenocarcinoma will depend less and less on reflux symptoms.…”