Gut Liver.  2017 May;11(3):358-362. 10.5009/gnl16081.

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

• Ortiz V
• Alvarez-Sotomayor D
• Sáez-González E
• Díaz-Jaime FC
• Iborra M
• Ponce J
• Garrigues

• KMID: 2412208
• DOI: http://doi.org/10.5009/gnl16081

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.

Keyword

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

MeSH Terms

Adult
Cross-Sectional Studies
Delayed Diagnosis
Esophagus/physiopathology
Female
Gastroesophageal Reflux/diagnosis/etiology/*physiopathology
Humans
Male
Middle Aged
Obesity, Morbid/complications/*physiopathology
Risk Factors
Symptom Assessment/*methods