Abstract
Background
Gastroesophageal reflux disease (GERD) is common in obese individuals. Prospective
studies investigating validated GERD questionnaires and clinical parameters at identifying
erosive esophagitis (EE) in this population are limited.
Objective
To prospectively evaluate the prevalence of GERD in obese patients considered for
bariatric surgery and identify risk and predictive factors for EE.
Methods
Eligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom
Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy.
Results
242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean
BMI 40.4 ± 5.3 kg/m2). The overall prevalence of gastroesophageal reflux (GERDQ ≥ 8, EE and/or PPI use)
was 62.4%. EE was identified in 82 patients (33.9%) including 13/62 (21.0%) receiving
PPIs at baseline. Multivariate logistic regression identified GERDQ ≥ 8 (OR = 6.3,
95%CI 3.0–13.1), hiatal hernia (OR = 4.2, 95%CI 1.6–10.7), abnormal Hill grade (OR = 2.7,
95%CI 1.4–5.4), and tobacco use (OR = 2.5, 95%CI 1.2–4.9) as independent risk factors
for EE. A pre-endoscopic composite assessment including GERDQ ≥ 8 and presence of
severe nocturnal reflux symptoms had 90% specificity and 20.7% sensitivity in identifying
EE (NPV 68.9% and PPV 51.5%).
Conclusion
GERD is highly prevalent in obese patients. Anthropometric data and GERD questionnaires
have limited accuracy at predicting erosive disease. Pre-operative endoscopic assessment
in this population appears warranted.
Keywords
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Article info
Publication history
Published online: May 07, 2019
Accepted:
April 10,
2019
Received:
December 3,
2018
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
