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

Fecha de publicación: 15/05/2017

Autores de IIS La Fe

• Vicente Ortiz Bellver

  Autor

• Diego Alvarez De Sotomayor Bierman

  Autor

• Esteban Sáez González

  Autor

• Francia Carolina Diaz Jaimen

  Autor

• Marisa Iborra Colomino

  Autor

• Julio Ponce Garcia

  Autor

• Vicente Garrigues Gil

  Autor

Grupos

• Enfermedad Inflamatoria Intestinal

  

  Leader

  Pilar Nos Mateu

Abstract

Background/Aims: To evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure. Methods: We 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. Results: MO 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). Conclusions: Silent 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.

Keywords

• Obesity; Acid reflux; pH monitoring; Gastroesophageal reflux; Sensitivity