Elevated body mass disrupts the barrier to gastroesophageal reflux - Discussion

Hypothesis: Obesity impairs the antireflux function of a structurally intact barrier. Design: Retrospective analysis of body mass index in patients with normal esophageal manometric findings but with symptomatic and objectively confirmed gastroesophageal reflux. Setting: Specialist esophageal center. Patients: Patients symptomatic and diagnostic for gastroesophageal reflux, referred between October 1, 1998, and June 30, 2000. Exclusion criteria were a defective barrier, motility disorders, or previous surgery. Main Outcome Measures: Reflux was defined and quantified using the DeMeester score, and body mass index was calculated. Results: There was a strong correlation between body mass index and severity of gastroesophageal reflux. Patients who were overweight had significantly higher distal esophageal acid exposure. No significant difference in manometric findings was demonstrated between patients with normal weight and those who were overweight. Conclusion: The barrier to gastroesophageal reflux is rendered insufficient in patients who are overweight.