News
Heartburn and Obesity
Donald Castell, MD
September 20, 2007 – Heartburn is the major symptom occurring in patients suffering from reflux of stomach acid into the esophagus, a condition commonly known as GERD (gastroesophageal reflux disease). A recent report in the Sept 14 issue of World Journal of Gastroenterology suggests that there may be an association between obesity and GERD, particularly in women. This comes as no surprise to those of us who have spent a career studying the esophagus and its diseases.
Many recent reports focus on the relationship between a person's BMI (body mass index) and GERD, with increasing GERD symptoms noted as BMI increases. This has been seen in both men and women. Possible contributing factors include the development of a hiatal hernia and also the size and components of the diet. When the upper portion of the stomach slides through the esophageal hiatus in the diaphragm into the chest cavity (i.e. hiatal hernia) it weakens the effectiveness of the lower esophageal sphincter to protect against GERD. It has long been suspected, and recently documented, that these events are more likely to occur with increasing obesity.
In the obese population, the diet is likely to consist of larger meals with higher contents of fat. Both of these are factors well known to contribute to increased reflux, raising the question of which came first, the dietary abnormalities or the obesity. In women, the effect of hormones such as estrogen and progesterone to potentially relax the lower esophageal sphincter may also contribute to an increased risk for GERD, as also suggested by Corazziari and his research team. Although many faceted, the relationship between obesity and GERD is well established, making diet and weight control important components of treatment of this common condition.