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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The association of sex, age, relative weight, smoking and drinking habits, chronic obstructive pulmonary disease (COPD) and economic and marital status, with benign oesophageal disease (BOD) was investigated by means of a point-prevalence study of BOD in a Danish population. A total of 346 individuals, representing subjects who gave positive responses to the discriminating questions pertaining to BOD and risk factors in a previously described questionnaire, as well as control subjects, were invited to participate in a clinical examination. Invasive investigation was accepted by 175 subjects, 114 of whom were diagnosed as having BOD. A statistically significant relationship between BOD and COPD was demonstrated by univariate analysis, and later confirmed by multivariate analysis (P less than 0.01). Odds ratios suggested a non-significant association between BOD and smoking at least 20 g tobacco a day and consuming greater than or equal to 50 alcoholic drinks per week. Obesity, sex, age, marital and economic status were not risk factors for BOD.
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PMID:Risk factors for benign oesophageal disease in a random population sample. 206 10

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72

Exophiala jeanselmei was isolated from three esophageal cultures over an 11-month period at Lutheran General Hospital. We believe this provides evidence for a new site of isolation, since previous reports of the organism's incidence were confined to skin and lung. Case 1 is an eight-year-old female with a three-year history of gagging and vomiting. Esophagoscopy revealed a mass biopsied as vegetable material. Case 2 is a 66-year-old retired male with a history of obesity, diabetes and spinal stenosis. Following back surgery, the patient developed odynophagia. Esophageal biopsies showed ulceration and bacterial colonies with no evidence of fungus. Case 3 is a 62-year-old male gardener who is also a nail biter. Esophagoscopy revealed a gastro-esophageal stricture with reflux and evidence of a hiatus hernia. Material biopsied was consistent with Barrett's esophagus and evidence of fungi was seen. The esophageal mass of case 1 and the esophageal brushings of case 2 and 3 grew E. jeanselmei. Aspiration, reflux, and mechanical disruption of the esophageal mucosa are possible predisposing factors in colonization of esophageal lesions by this ubiquitous, normally low virulence organism.
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PMID:Isolation of Exophiala jeanselmei associated with esophageal pathology--three cases, laboratory and clinical features. 649 12

Esophageal manometry was performed in a group of extremely obese subjects in order to investigate the lower esophageal sphincter (LES) pressure and its relationship to extreme obesity, weight reduction and altered anatomy of the stomach. Forty subjects were examined before gastric surgery for treatment of their obesity, and 14 of these were reexamined after weight reduction. Normal LES pressure (20 mmHg) was found before operation, and also normal length and position of the LES. No significant changes were found in the group which was examined twice. In persons younger than 50, LES manometric findings do not seem to be influenced by extreme obesity, weight reduction or gastric surgery for obesity.
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PMID:Manometric studies of lower esophageal sphincter in extreme obesity. 688 May 55

OSAS, a common cause of disrupted sleep and EDS, result from repetitive closure of the upper airway during sleep. It probably represents the most severe syndrome related to obstruction of the upper airway; less severe forms include UARS, a syndrome characterized by the need for increased effort to breath but no prominent apneas or hypopneas, and primary snoring. Initial clues to the presence of OSAS and related disorders are derived from the history and include loud snoring, EDS or insomnia, and witnessed apneas. Some patients, especially women, may complain mostly of tiredness or fatigue, and children may present with behavioral abnormalities. Obesity, a large neck circumference, and a crowded oropharynx are common on physical examination. Nonobese patients, in particular, often have retrognathia, a high-arched narrow palate, macroglossia, enlarged tonsils, temporomandibular joint abnormalities, or chronic nasal obstruction. The clinical suspicion of obstructed nocturnal breathing is confirmed by overnight polysomnography, and an MSLT may be used to assess sleepiness. Esophageal manometry during polysomnography facilitates diagnosis of UARS. Treatment most commonly consists of nasal CPAP or BPAP, although problems with compliance make surgical treatment preferable in some cases. Although UPPP eliminates sleep apnea only in a minority of patients, combining UPPP with maxillofacial procedures appears to improve outcomes. Other treatments such as the use of dental appliances or medications, weight loss, and positional therapy may be useful as adjunctive therapy for moderate to severe OSAS or as primary treatments for UARS or mild OSAS.
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PMID:Obstructive sleep apnea and related disorders. 887 78

The incidence of adenocarcinoma of the esophagus and esophagogastric junction (EGJ) has been increasing over the past 15 years in western countries. Surgical series and population-based studies show that, by 1994, adenocarcinomas of the esophagus accounted for half of all esophageal cancer among white men. The causes of this increase in incidence remain to be elucidated. Esophageal adenocarcinomas and a portion of EGJ adenocarcinomas arise from long and short segments of specialized intestinal metaplasia (Barrett's esophagus). The prevalence of long segments of Barrett's esophagus (> 3 cm) in patients having endoscopy for reflux symptoms is 3%, and 1% in those undergoing endoscopy for any clinical indication. However, a silent majority of patients with Barrett's esophagus remain unrecognized in the general population and may not be diagnosed unless adenocarcinoma develops. Recent studies document a rise in the diagnosis of specialized intestinal metaplasia of the cardia. Nearly all these patients have associated carditis, and Helicobacter pylori infection has been linked to this condition. The possible origin of EGJ adenocarcinomas in the sequence carditis--specialized intestinal metaplasia needs to be clarified. Smoking and obesity are additional risk factors for adenocarcinoma of the esophagus and EGJ. Current data does not confirm H. pylori as a risk factor for cancer of the EGJ.
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PMID:Epidemiology of esophageal cancer, especially adenocarcinoma of the esophagus and esophagogastric junction. 1069 34

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.
Dis Esophagus 2001
PMID:Obesity and its effect on outcome of laparoscopic Nissen fundoplication. 1142 6

Gastrointestinal cancer is a major medical and economic burden worldwide. Oesophageal and gastric cancers are most common in the non-industrialized countries, while colorectal cancer is the predominant gastrointestinal malignancy in westernized countries. Their aetiology is mainly related to correctable and preventable lifestyle habits; namely diet (including obesity), physical activity, alcohol and tobacco intake, and sanitation. Prevention and/or treatment of Helicobacter pylori infection would significantly reduce the prevalence of gastric cancer. Screening for cancer, its early detection and treatment requires medical facilities, endoscopic expertise and a major investment of national financial resources. This is only feasible in affluent industrialized countries such as Japan for gastric cancer, some western countries for oesophageal and colorectal cancer. Only population screening for colorectal cancer has been proven feasible and cost-beneficial.
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PMID:Cancer of the gastrointestinal tract: early detection or early prevention? 1507 91

Gastroesophageal reflux disease (GERD) is common in obese patients. The implications of obesity in the etiology, management and outcomes in treatment for GERD have become increasingly important due to an epidemic of obesity. The increasing prevalence of patients with both obesity and GERD merits evaluation of the appropriate surgical intervention for GERD and its symptoms. With the additional advantages of weight loss and resolution of weight-related morbidity (including GERD) bariatric procedures should be the procedure of choice in patients with medically complicated obesity. Patients in lower obesity classes with body mass indices (BMI) of 30-35 kg/m2 without other substantive weight-related comorbidity should prompt consideration of both fundoplication and bariatric procedures, tailoring the best approach based on the specific patient and future implications. Patients classified as overweight but not obese (BMI < 30) are likely best treated with fundoplication; however, no randomized trials comparing fundoplication with the current antireflux bariatric procedures exist.
Dis Esophagus 2006
PMID:Gastroesophageal reflux disease in obese patients: the role of obesity in management. 1664 70

The aim of this study was to examine the association of obesity with esophageal adenocarcinoma, and with the precursor lesions Barrett esophagus and gastroesophageal reflux disease (GERD). This case-control study included cases with GERD (n = 142), Barrett esophagus (n = 130), and esophageal adenocarcinoma (n = 57). Controls comprised 102 asymptomatic individuals. Using logistic regression methods, we compared obesity rates between cases and controls adjusting for differences in age, gender, and lifestyle risk factors. Relative to normal weight, obese individuals were at increased risk for esophageal adenocarcinoma (Odds Ratio [OR] 4.67, 95% Confidence Interval [CI] 1.27-17.9). Diets high in vitamin C were associated with a lower risk for GERD (OR 0.40, 95% CI 0.19-0.87), Barrett esophagus (OR 0.44, 95% CI 0.20-0.98), and esophageal adenocarcinoma (OR 0.21, 95% CI 0.06-0.77). For the more established risk factors, we confirmed that smoking was a significant risk factor for esophageal adenocarcinoma, and that increased liquor consumption was associated with GERD and Barrett esophagus. In light of the current obesity epidemic, esophageal adenocarcinoma incidence rates are expected to continue to increase. Successful promotion of healthy body weight and diets high in vitamin C may substantially reduce the incidence of this disease.
Dis Esophagus 2006
PMID:Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. 1698 26


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