Association of Body Mass Index and Gastroesophageal Reflux Disease and Its Complications Such as Hiatus Hernia, Reflux Esophagitis and Barrett's Esophagus, a Retrospective Study

Abstract

Introduction: Obesity is a fast-emerging epidemic in the Asia-Pacific region especially in Malaysia. According to National health and morbidity survey of 2015, obesity in Malaysians make up 17.7% of the population out of these 30% are overweight. Gastroesophageal reflux diseases are being affected greatly by obesity. Objectives: To determine the association between GERD complications such as hiatus hernia,  reflux esophagitis  and Barrett's esophagus with body mass index via esophagogastroduodenoscopy (OGDS) in The school of medicine, University Sains Malaysia. Methods: Study included retrospective analysis of 127 GERD patients with GerdQ questionaire scoring system treated by OGDS. The patients were divided into 2 groups according to their body mass index (BMI) comprising of Group 1 i.e. Normal BMI group with BMI less than 22.9 kg / (m2)   (54  patients) and Group 2 comprising of obese patients with the BMI more than 23 kg / (m2) (73 paients). The clinical factors (age, gender, ethinicity, weight, height, BMI and GerdQ questionaire scoring) and OGDS findings (hiatus hernia, reflux esophagitis and Barrett's esophagus) were analyzed. OGDS films were classified as Hiatus hernia, reflux esophagitis and Barrett's esophagus. Results:  The mean age of the patients were 43.91 years old. Obesity as in BMI > 30 kg/m2 were statistically significant association with Hiatus hernia and statistically significant association with reflux esophagitis. However, obesity was statistically insignificant association with Barrett's esophagus. Obese patient also showed statistically insignificant association with Barrett's esophagus endoscopically Circumferential of metaplasia and Maximum extend of metaplasia (M). The risk prediction shows statistically significant association between Body Mass Index with reflux esophagitis based. Those in obese group had 3.6 times higher Odds to get reflux esophagitis symptoms compared to those in normal BMI group. Conclusion:  Obese patient had association with hiatus hernia and reflux esophagitis, but not for the Barrett's esophagus. The risk prediction association between Body Mass Index is with reflux esophagitis based in obese group had 3.6 times symptoms compared to those in normal BMI group. In obese patient with GERD symptoms LRYGB was suggested as it is more effective procedure for alleviating the symptoms of GERD as it plays a role in significant weight loss without altering the anatomy of the LES and increasing intragastric pressure.