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Pathophysiology of Gastroesophageal Reflux Disease in Obese Patients

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Abstract

Gastroesophageal reflux disease (GERD) and obesity coexist in many patients. The association is not coincidental, since obesity plays a major role in the pathophysiology of GERD. Obesity is associated with a higher number of transient lower esophageal sphincter relaxations and abnormal peristalsis. Central obesity increases the trans-diaphragmatic pressure gradient and disrupts the anatomy of the gastroesophageal junction by causing hiatal hernia formation. Obese patients benefit from weight loss: this can be achieved by diet and exercise but bariatric surgery today plays an important role, as it determines a more pronounced and durable weight loss and partial or complete resolution of most obesity-associated comorbidities. Today, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are the most common bariatric operations used for the treatment of morbidly obese patients.

This chapter focuses on the pathophysiology of GERD in obese patients and on the impact of both sleeve gastrectomy and Roux-en-Y gastric bypass on GERD.

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References

  1. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80.

    Article  PubMed  Google Scholar 

  2. Zvenyach T, Pickering MK. Health care quality: measuring obesity in performance frameworks. Obesity. 2017;25:1305–12.

    Article  PubMed  Google Scholar 

  3. Chang P, Friedenberg F. Obesity and GERD. Gastroenterol Clin N Am. 2014;43:161–73.

    Article  Google Scholar 

  4. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354:2340–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.

    Article  PubMed  Google Scholar 

  6. Stein DJ, El-Serag HB, Kuczynski J, et al. The association of body mass index with Barrett’s oesophagus. Aliment Pharmacol Ther. 2005;22:1005–10.

    Article  CAS  PubMed  Google Scholar 

  7. Corley DA, Kubo A, Levin TR. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41.

    Article  PubMed  Google Scholar 

  8. Pohl H, Wrobel K, Bojarski C, et al. Risk factors in the development of esophageal adenocarcinoma. Am J Gastroenterol. 2013;108:200–7.

    Article  PubMed  Google Scholar 

  9. Hoyo C, Cook MB, Kamangar F, et al. Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium. Int J Epidemiol. 2012;41:1706–18.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Quiroga E, Cuenca-Abente F, Flum D. Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance. Surg Endosc. 2006;20:739–43.

    Article  CAS  PubMed  Google Scholar 

  11. Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–90.

    Article  PubMed  Google Scholar 

  12. Valezi AC, Herbella FA, Junior JM, de Almeida Menezes M. Esophageal motility after laparoscopic Roux-en-Y gastric bypass: the manometry should be preoperative examination routine? Obes Surg. 2012;22:1050–4.

    Article  PubMed  Google Scholar 

  13. Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.

    Article  PubMed  Google Scholar 

  14. Schneider JH, Keuper M, Keonigsrainer A, Breucher B. Transient lower esophageal sphincter relaxation in morbid obesity. Obes Surg. 2009;19:595–600.

    Article  CAS  PubMed  Google Scholar 

  15. Lee YY, McColl KEL. Pathophysiology of gastroesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2013;27:339–51.

    Article  CAS  PubMed  Google Scholar 

  16. Richter JE, Rubenstein JH. Gstroesophageal reflux disease – presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology. 2018;154:267–76.

    Article  PubMed  Google Scholar 

  17. Valezi AC, Herbella FA, Mali J Jr. Gastroesophageal reflux disease: pathophysiology. In: Fisichella PM, Allaix ME, Morino M, Patti MG, editors. Esophageal diseases. Evaluation and treatment. New York: Springer; 2014. p. 41–51.

    Google Scholar 

  18. Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.

    Article  CAS  PubMed  Google Scholar 

  19. Herbella FA, Patti MG. Gastroesophageal reflux disease: from pathophysiology to treatment. World J Gastroenterol. 2010;16:3745–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130:639–49.

    Article  PubMed  Google Scholar 

  21. Cote-Daigneault J, Leclerc P, Joubert J, Bouin M. High prevalence of esophageal dysmotility in asymptomatic obese patients. Can J Gastroenterol Hepatol. 2014;28:311–4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Koppman JS, Poggi L, Szomstein S, et al. Esophageal motility disorders in the morbidly obese population. Surg Endosc. 2007;21:761–4.

    Article  CAS  PubMed  Google Scholar 

  23. Gourcerol G, Benanni Y, Boueyre E, Leroi AM, Ducrotte P. Influence of gastric emptying on gastroesophageal reflux: a combined pH-impedance study. Neurogastroenterol Motil. 2013;25:800–4.

    CAS  PubMed  Google Scholar 

  24. Buchholz V, Berkenstadt H, Goitein D, Dickman R, Bernstine H, Rubin M. Gastric emptying is not prolonged in obese patients. Surg Obes Relat Dis. 2013;9:714–7.

    Article  PubMed  Google Scholar 

  25. Mushref MA, Srinivasan S. Effect of high fat-diet and obesity on gastrointestinal motility. Ann Transl Med. 2013;1:14–7.

    PubMed  PubMed Central  Google Scholar 

  26. Nadaleto BF, Herbella FAM, Patti MG. Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery. 2016;159:475–86.

    Article  PubMed  Google Scholar 

  27. Shepherd K, Hillman D, Holloway R, Eastwood P. Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea. Sleep Breath. 2011;15:561–70.

    Article  PubMed  Google Scholar 

  28. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006;6:772–83.

    Article  CAS  PubMed  Google Scholar 

  29. Mion F, Dargent J. Gastro-oesophageal reflux disease and obesity: pathogenesis and response to treatment. Best Pract Res Clin Gastroenterol. 2014;28:611–22.

    Article  PubMed  Google Scholar 

  30. Knowles CH, Aziz Q. Visceral hypersensitivity in non-erosive reflux disease. Gut. 2008;57:674–83.

    Article  CAS  PubMed  Google Scholar 

  31. Velden vd A, de Wit NJ, Quartero AO. Maintenance treatment for GERD: residual symptoms are associated with psychological distress. Digestion. 2008;77:207–13.

    Article  Google Scholar 

  32. Schey R, Dickman R, Parthasarathy S. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007;133:1787–95.

    Article  PubMed  Google Scholar 

  33. Fass R, Naliboff BD, Fass SS. The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134:696–705.

    Article  PubMed  Google Scholar 

  34. De Groot NL, Burgerhart JS, Van De Meeberg PC, de Vries DR, Smout AJ, Siersema PD. Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2009;30:1091–102.

    Article  PubMed  Google Scholar 

  35. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.

    Article  PubMed  Google Scholar 

  36. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012;8:8–19.

    Google Scholar 

  37. Soricelli E, Iossa A, Casella G, Abbatini F, Cali B, Basso N. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9:356–61.

    Article  PubMed  Google Scholar 

  38. Braghetto I, Csendes A, Korn O, Valladares H, Gonzalez P, Henriquez A. Gastroesophageal reflux disease after sleevebgastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20:148–53.

    Article  PubMed  Google Scholar 

  39. Fraser-Moodie CA, Norton B, Gornall C. Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol. 1999;34:337–40.

    Article  CAS  PubMed  Google Scholar 

  40. Burton PR, Brown WA, Laurie C, Korin A, Yap K, Richards M. Pathophysiology of laparoscopic adjustable gastric bands: analysis and classification using high-resolution video manometry and a stress barium protocol. Obes Surg. 2010;20:19–29.

    Article  PubMed  Google Scholar 

  41. Cruiziat C, Roman S, Robert M, Espalieu P, Laville M, Poncet G. High resolution esophageal manometry evaluation in symptomatic patients after gastric banding for morbid obesity. Dig Liver Dis. 2011;43:116–20.

    Article  PubMed  Google Scholar 

  42. Tandon A, Rao R, Hotouras A, Nunes QM, Hartley M, Gunasekera R, Howes N. Safety and effectiveness of antireflux surgery in obese patients. Ann R Coll Surg Engl. 2017;99:515–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Mandeville Y, Looveren R, Vancoillie PJ, et al. Moderating the enthusiasm of sleeve gastrectomy: up to fifty percent of reflux symptoms after ten years in a consecutive series of one hundred laparoscopic sleeve gastrectomy. Obes Surg. 2017;27:1797–803.

    Article  PubMed  Google Scholar 

  44. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13:568–74.

    Article  PubMed  Google Scholar 

  45. Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. A physiopathologic evaluation. Ann Surg. 2014;260:909–15.

    Article  PubMed  Google Scholar 

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Conflict of Interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marco G. Patti

  2. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marco G. Patti & Timothy M. Farrell

  3. Department of Surgery, Hospital Aleman, Buenos Aires, Argentina

    Francisco Schlottmann

Authors
  1. Marco G. Patti
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  2. Francisco Schlottmann
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  3. Timothy M. Farrell
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Corresponding author

Correspondence to Marco G. Patti .

Editor information

Editors and Affiliations

  1. Department of Surgery, Sacré-Coeur Hospital, Montréal, QC, Canada

    Michel Gagner

  2. Bariatric Surgery, Gastro Obeso Center, Sao Paulo, Brazil

    Almino Ramos Cardoso

  3. Diagnomed, University of Buenos Aires, Buenos Aires, Argentina

    Mariano Palermo

  4. Emirates Specialty Hospital, Dubai, United Arab Emirates

    Patrick Noel

  5. CHU Montpellier, Saint Gely du Fesc, France

    David Nocca

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Patti, M.G., Schlottmann, F., Farrell, T.M. (2020). Pathophysiology of Gastroesophageal Reflux Disease in Obese Patients. In: Gagner, M., Cardoso, A., Palermo, M., Noel, P., Nocca, D. (eds) The Perfect Sleeve Gastrectomy. Springer, Cham. https://doi.org/10.1007/978-3-030-28936-2_14

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  • DOI: https://doi.org/10.1007/978-3-030-28936-2_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28935-5

  • Online ISBN: 978-3-030-28936-2

  • eBook Packages: MedicineMedicine (R0)

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