Article Sidebar
Main Article Content
Associations of Metabolically Healthy Obesity with Gastroesophageal Reflux Disease and Ineffective Esophageal Motility
Main Article Content
Abstract
Background/Aims: Obesity correlates with a higher prevalence of gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM); however, the connection between metabolic obesity phenotype and these symptoms is poorly explored. Here, empirical data were used to explore the relationships between phenotypes of metabolic obesity and GERD and IEM.
Materials and Methods: The present retrospective study involved 605 patients demonstrating typical reflux symptoms, categorized into 4 phenotypes: metabolically healthy obesity (MHO), metabolically healthy non-obesity (MHNO), metabolically unhealthy obesity (MUO), and metabolically unhealthy non-obesity (MUNO). The study excluded cases who were underweight, with severe comorbidities, prior gastric surgeries, or an absence of complete data. A 24-hour multichannel intraluminal impedance-pH system was used for monitoring.
Results: Patients exhibiting MUO, MHO, and MUNO phenotypes demonstrated a higher risk of GERD (pathological acid exposure time (AET), >6%) and IEM compared to those with the MHNO phenotype. Potential confounders, such as sex, age, body mass index, waist–hipratio, smoking status, alcohol intake, psychosocial stress, socioeconomic status, dietary practices, and opioid usage were adjusted, with the results indicating that the MUO phenotype was linked to the highest risk of pathological AET [15.78 (95% CI: 4.72-52.73)]; IEM [3.00 (95% CI: 1.31-6.87)].
Conclusion: The effects of obesity on GERD and IEM incidence could exceed those of metabolic diseases.
Cite this article as: He T, Su L, Song S, Li Y, Wang L, Sun S. Associations of metabolic obesity phenotypes with gastroesophageal reflux disease and esophageal dysmotility. Turk J Gastroenterol. 2025;36(6):371-380.
Article Details
References
1. Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal reflux disease: a review. JAMA. 2020;324(24):2536-2547. [CrossRef]
2. Nocon M, Labenz J, Jaspersen D, et al. Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of gastroesophageal reflux Disease study. J Gastroenterol Hepatol. 2007;22(11):1728-1731. [CrossRef]
3. Rogers BD, Patel A, Wang D, Sayuk GS, Gyawali CP. Higher esophageal symptom burden in obese subjects results from increased esophageal acid exposure and not from dysmotility. Clin Gastroenterol Hepatol. 2020;18(8):1719-1726. [CrossRef]
4. Koppman JS, Poggi L, Szomstein S, Ukleja A, Botoman A, Rosenthal R. Esophageal motility disorders in the morbidly obese population. Surg Endosc. 2007;21(5):761-764. [CrossRef]
5. Burgerhart JS, van de Meeberg PC, Siersema PD, Smout AJPM. Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur J Gastroenterol Hepatol. 2014;26(1):6-10. [CrossRef]
6. Lee YB, Kim DH, Kim SM, et al. Hospitalization for heart failure incidence according to the transition in metabolic health and obesity status: a nationwide population-based study. Cardiovasc Diabetol. 2020;19(1):77. [CrossRef]
7. Fu S, Xu M, Zhou H, Wang Y, Tan Y, Liu D. Metabolic syndrome is associated with higher rate of gastroesophageal reflux disease: a meta-analysis. Neurogastroenterol Motil. 2022;34(5):e14234. [CrossRef]
8. Stefan N, Häring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013;1(2):152-162. [CrossRef]
9. Allen JI. Endoscopy for gastroesophageal reflux disease: choose wisely. Ann Intern Med. 2012;157(11):827-828. [CrossRef]
10. Savarino E, Zentilin P, Frazzoni M, et al. Characteristics of gastro-esophageal reflux episodes in Barrett’s esophagus, erosive esophagitis and healthy volunteers. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2010;22(10):1061-e1280. [CrossRef]
11. Gyawali CP, Rogers B, Frazzoni M, Savarino E, Roman S, Sifrim D. Inter-reviewer variability in interpretation of pH-impedance studies: the Wingate consensus. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterological Assoc. 2021;19(9):1976-1978.
12. Frazzoni M, Savarino E, de Bortoli N, et al. Analyses of the postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 2016;14(1):40-46. [CrossRef]
13. Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361-371. [CrossRef]
14. Frazzoni L, Frazzoni M, De Bortoli N, et al. Application of Lyon Consensus criteria for GORD diagnosis: evaluation of conventional and new impedance-pH parameters. Gut. 2022;71(6):1062-1067. [CrossRef]
15. Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterol Motil. 2021;33(1):e14058. [CrossRef]
16. Shaker A, Stoikes N, Drapekin J, Kushnir V, Brunt LM, Gyawali CP. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108(11):1706-1712. [CrossRef]
17. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157-163. [CrossRef]
18. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment Panel III). JAMA. 2001;285(19):2486-2497. [CrossRef]
19. Valezi AC, Herbella FAM, Schlottmann F, Patti MG. Gastroesophageal reflux disease in obese patients. J Laparoendosc Adv Surg Tech A. 2018;28(8):949-952. [CrossRef]
20. Ortiz V, Alvarez-Sotomayor D, Sáez-González E, et al. Decreased esophageal sensitivity to acid in morbidly obese patients: a cause for concern? Gut Liver. 2017;11(3):358-362. [CrossRef]
21. Blevins CH, Dierkhising RA, Geno DM, et al. Obesity and GERD impair esophageal epithelial permeability through 2 distinct mechanisms. Neurogastroenterol Motil. 2018;30(10):e13403. [CrossRef]
22. Gibbens YY, Lansing R, Johnson ML, Blevins CH, Katzka DA, Iyer PG. Effects of central obesity on esophageal epithelial barrier function. Am J Gastroenterol. 2021;116(7):1537-1541. [CrossRef]
23. Schneider JME, Brücher BLDM, Küper M, Saemann K, Königsrainer A, Schneider JH. Multichannel intraluminal impedance measurement of gastroesophageal reflux in patients with different stages of morbid obesity. Obes Surg. 2009;19(11):1522-1529. [CrossRef]
24. Hajar N, Castell DO, Ghomrawi H, Rackett R, Hila A. Impedance pH confirms the relationship between GERD and BMI. Dig Dis Sci. 2012;57(7):1875-1879. [CrossRef]
25. Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357-362. [CrossRef]
26. Xie C, Wang J, Li Y, et al. Esophagogastric junction contractility integral reflect the anti-reflux barrier dysfunction in patients with gastroesophageal reflux disease. J Neurogastroenterol Motil. 2017;23(1):27-33. [CrossRef]
27. Yen HH, Tseng PH, Shih MC, Yang PJ, Lin MT, Lee PC. Derangement of esophageal anatomy and motility in morbidly obese patients: a prospective study based on high-resolution impedance manometry. Surg Obes Relat Dis. 2020;16(12):2006-2015. [CrossRef]
28. Rogers BD, Rengarajan A, Ribolsi M, et al. Postreflux swallow-induced peristaltic wave index from pH-impedance monitoring associates with esophageal body motility and esophageal acid burden. Neurogastroenterol Motil. 2021;33(2):e13973. [CrossRef]