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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty consecutive massively obese patients referred for gastroplasty operations were prospectively studied to determine the existence of gastroesophageal reflux disease by means of a standardized questionnaire, 24-hr ambulatory pH-metry, and endoscopy (27 females, mean age 48 years, range 38-57 years). These patients had a body mass index (BMI) of 42.5 +/- 5.2 kg/m2 and an actual weight of 125.5 +/- 17 kg. Heartburn and acid regurgitation was reported by 37% and 28%, respectively, mostly of a mild degree (22% and 20%). Dysphagia was reported by 2%, but none had odynophagia. No patient had any macroscopic esophagitis. The pH data were compared with those obtained in 29 age- and sex-matched, symptom-free, healthy controls (15 females, mean age 47.6 years, range 30-63 years). During ambulatory pH-metry, we recorded a predominance of daytime reflux (7.2 +/- 8.2% and total acid exposure of 5.3 +/- 6.4%) in the obese patients, but neither the weight, BMI, nor the waist-hip ratio were significantly correlated with any of the reflux variables. The pH data obtained from these patients did not, however, differ significantly from those recorded in the control population, although a somewhat lower daytime acid reflux was found in the latter group. These results suggest that massive overweight is not associated with an increased prevalence of gastroesophageal reflux disease.
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PMID:Does massive obesity promote abnormal gastroesophageal reflux? 764 61

Symptoms suggestive of gastro-oesophageal reflux disease are very common. The aim of the study was to assess the prevalence of these symptoms and factors influencing them in an unselected adult population. A questionnaire was mailed to a random sample of 2500 people aged > or = 20 years. The questions concerned heartburn, regurgitation, dysphagia, chest and upper abdominal pain, as well as medication and medical consultations for these symptoms. Of the 1700 (68%) responders, 9% had experienced heartburn on the day of response and 15%, 21% and 27% during the preceding week, month and year, respectively. The corresponding figures for regurgitation were 5, 15, 29 and 45%. During the past year 43% of the study group had had no such symptoms. Age, overweight, pregnancy and cigarette smoking significantly influenced the prevalence of symptoms. Using daily heartburn and/or regurgitation as dominant indicators 10.3% (95% CI 12-11.7) of the responders had gastro-oesophageal reflux disease. Medication (most commonly antacids) was used by only 16% of the symptomatic people, and only 5.5% had sought medical advice for symptoms during the past year. Thus, despite commonness of symptoms suggestive of gastro-oesophageal reflux disease only a minority of the individuals suffering from such symptoms use medication or have medical consultation.
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PMID:Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population. 774 2

New knowledge concerning the pathophysiology of gastroesophageal reflux gives an opportunity for updating measures of conservative antireflux treatment. There are only few controlled trials, and it is uncertain whether the requirement for pharmacological treatment may hereby be diminished. General advice such as eating small meals, reducing the fat intake, avoiding food intake for three hours before bedtime are recommended to all, while advice on more specific foods should be individualized according to actual food related symptoms. Patients with annoying symptoms of reflux are advised not to consume alcohol every day, while the consumption of tobacco seems to be of minor importance. Advising weight loss isn't well founded, but ought to be given to obese patients. Elevation of the head of the bed is suggested to patients with nocturnal symptoms of reflux, which usually coincide with the presence of a hiatal hernia. If possible, revision of other current pharmacotherapy should be done. Theophylline, calcium channel blockers, benzodiazepines and nonsteroidal antiinflammatory drugs, seem in particular to be able to provoke or aggravate reflux. Patient support groups with medical supervision might be useful and reduce the number of consultations. The non-pharmacological measures should still be the basis of treatment and it might be sufficient in mild cases. It is recommended that the advise be individualized to each patient in such a way that no unfounded changes of life style are recommended that impair the quality of life. Gastroesophageal reflux, nonpharmacological treatment, food advices, alcohol, tobacco, overweight, hiatal hernia, drugs, patient education.
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PMID:[Non-pharmacological therapeutic possibilities in gastroesophageal reflux dyspepsia]. 794 Oct 49

Morbid obesity is related to a severe decrease in life expectancy. No medical or dietary treatment offers an alternative to control hypertension, apnea syndrome, orthopedic diseases, ..., caused by overweight. With respect to a serious preoperative evaluation and a severe selection (psychologic, dietetic, ...) Silastic Ring Vertical Gastroplasty is considered in our experience (more than 300 cases) and in the literature as the gold standard for surgical treatment of obesity. The long term follow-up (24-66 months) of 100 consecutive operated patients shows a positive response on hypertension (96%), apnea syndrome (92%), diabetes (85%), gastroesophageal reflux (76%), orthopedic diseases (74%) and cardiorespiratory insufficiency (74%). Considering our experience in the medical and surgical management of patients operated in our department or referred from other centers for complications after different procedures, we actually propose SRVG as the treatment of choice for morbid obesity.
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PMID:[The treatment of morbid obesity with gastroplasty]. 892 52

Obesity has long been suspected as predisposing to gastroesophageal reflux disease, and it has also been claimed that it is an important cause of poor outcome following laparoscopic anti-reflux surgery. This study was performed to determine the validity of this proposition. The outcome of 194 patients from an overall experience of 971 laparoscopic anti-reflux procedures was determined in this study. Patients were included if they had undergone a laparoscopic Nissen fundoplication, had completed a minimum 12 months follow-up using a structured questionnaire, and had data available for the calculation of their preoperative body mass index (BMI). Patients were divided into three groups based on BMI: normal weight (BMI < 25), overweight (BMI 25-29.9), and obese (BMI >30). The association between BMI and outcome data from their most recent follow-up was analyzed. There was no correlation between increasing BMI and a poorer overall outcome. There was a slight trend toward less satisfaction with the surgical outcome in patients of normal weight. Preoperative obesity is not associated with a poorer outcome following laparoscopic Nissen fundoplication.
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PMID:Obesity and its effect on outcome of laparoscopic Nissen fundoplication. 1142 6

Obesity is the most prevalent and serious nutritional disease among western countries and is rapidly replacing undernutrition as the most common form of malnutrition in the world. Approximately 300,000 deaths a year are currently associated with overweight and obesity, second only to cigarette smoking as a leading cause of preventable death in the United States. Obesity effects 9 organ systems and is a risk factor for gastroesophageal reflux disease, nonalcoholic fatty liver disease, cholelithiasis, and colon cancer. Evidence-based guidelines on the identification, evaluation, and treatment of overweight and obesity have recently been developed by the National Institutes of Health to help practitioners effectively manage their patients. The body mass index is used to classify weight status and risk of disease. Treatment for obesity includes lifestyle management, consisting of diet therapy, physical activity, and behavioral modification, and may include pharmacotherapy or surgery based on level of risk. Currently only 2 medications, sibutramine and orlistat, are approved for long-term use. An initial weight loss of 10% of body weight achieved over 6 months is a recommended target. This article reviews the evaluation and management of the adult obese patient.
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PMID:Medical management of obesity. 1223 Mar 15

The aim of this study was to assess, with a specially prepared questionnaire, the prevalence of reflux-like dyspepsia in a population of 40 patients morbidly obese, Body Mass Index (BMI) 46.2+/- 1.7 kg/m2, comparing the results with those deriving from the analysis of 20 healthy volunteers (BMI 20.9+/-1.7 kg/m2). The prevalence of esophageal symptoms in all obese patients was 45%, versus 15% in controls. There was a significant direct correlation between obesity and reflux-like dyspepsia (p<0.05). Patients who are morbidly overweight should be encouraged to lose weight, as the very first step in fighting Gastro-Esophageal Reflux Disease.
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PMID:[Reflux-like dyspepsia in obese patients]. 1258 5

Obesity has, among physicians, since long been considered to cause gastro-oesophageal reflux. The evidence in support of this belief has been scarce, however. During the last few years some population-based studies have addressed this clinically important issue. These studies demonstrated a clear and dose-dependent association between increasing degrees of overweight and gastro-oesophageal reflux. The mechanisms by which obesity causes reflux are unknown, although there is some limited data suggesting that hiatal hernia may be the causal link between obesity and reflux. Moreover, some evidence has been presented showing that obesity is clearly a stronger risk factor among women than among men, and that the relation between overweight and reflux is substantially augmented by postmenopausal hormone therapy. The data so far available point in the direction of oestrogens, the activity of which is strengthened by increasing body mass, being responsible for this effect. If the results are repeated in future studies, postmenopausal therapy might be avoided among obese females suffering from severe reflux. Weight-reduction seems to reduce the risk of symptomatic gastro-oesophageal reflux disease, indicating that such strategy might be a useful tool in the treatment of reflux.
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PMID:The relation between body mass and gastro-oesophageal reflux. 1556 42

Obesity has been shown to be a significant predisposing factor for gastroesophageal reflux disease (GERD). However, obesity is also thought to be a contraindication to antireflux surgery. This study was undertaken to determine if clinical outcomes after laparoscopic Nissen fundoplications are influenced by preoperative body mass index (BMI). From a prospective database of patients undergoing treatment for GERD, 257 consecutive patients undergoing laparoscopic Nissen fundoplication were studied. Patients were stratified by preoperative BMI: normal (<25), overweight (25-30), and obese (>30). Clinical outcomes were scored by patients with a Likert scale. Overweight and obese patients had more severe preoperative reflux, although symptom scores for reflux and dysphagia were similar among all weight categories. There was a trend toward longer operative times for obese patients. Mean follow-up was 26+/-23.9 months. Mean heartburn and dysphagia symptom scores improved for patients of all BMI categories (P<0.001). Postoperative symptom scores and clinical success rates did not differ among BMI categories. Most patients undergoing laparoscopic Nissen fundoplication are overweight or obese with moderate dysphagia and severe acid reflux. Clinical outcomes after laparoscopic Nissen fundoplication did not differ among patients stratified by preoperative BMI. Obesity is not a contraindication to laparoscopic Nissen fundoplication.
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PMID:Obesity is not a contraindication to laparoscopic Nissen fundoplication. 1613 90

The incidence and prevalence of gastro-oesophageal reflux disease is rising. Changing dietary habits and increasing body weight can be held responsible. In several studies a close relation was found between body weight and the occurrence of reflux disease. It may be concluded that there is a definite relation between body mass index and the occurrence of reflux disease. H. pylori probably also plays a role. H. pylori causes changes in fundic leptin levels and plasma levels of ghrelin. Eradication of H. pylori infection can increase appetite leading to a rise in body mass index due to a higher caloric intake. H. pylori can be a 'protective' factor against the development of overweight. Since only a minority of overweight or obese patients with gastro-oesophageal reflux disease will lose weight successfully, medical treatment with effective acid suppression will be the mainstay of the treatment of reflux disease in patients with a high body mass index.
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PMID:Helicobacter pylori, obesity and gastro-oesophageal reflux disease. Is there a relation? A personal view. 1699 Jun 98


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