Features of the phenotypic manifestations of GERD in its comorbidity with obesity
- Authors: Maev I.V.1, Yurenev G.L.1, Mironova E.M.1,2
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Affiliations:
- Russian University of Medicine
- Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies
- Issue: Vol 97, No 8 (2025): Treatment issues
- Pages: 635-641
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/314014
- DOI: https://doi.org/10.26442/00403660.2025.08.203364
- ID: 314014
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Abstract
Aim. To optimize the algorithm of diagnosis and treatment of patients with gastroesophageal reflux disease (GERD) with comorbid obesity based on a comprehensive analysis of the clinical and functional characteristics of the disease.
Materials and methods. The study included 150 patients who underwent esophagogastroduodenoscopy, 24-hour pH-measurement or 24-hour pH-impedancometry of the esophagus. A stratification was carried out basing on the presence of typical GERD complaints and body mass index (BMI). Group 1 consisted of 30 patients with GERD and normal body weight; group 2 – 60 patients with GERD who were overweight or obese; group 3 – 30 patients without GERD, but overweight or obese; control group – 30 people with normal body weight without GERD, but with similar complaints due to functional disorders of the esophagus.
Results. When comparing esophageal pH-impedancometry data, it was found that the volume clearance time did not differ between the groups of patients with normal body weight and overweight, but in obese people reflux with pH > 7 was recorded more often and for a longer time. The duration of chemical clearance (DCC) was increased in both groups, however, with overweight (BMI > 25 kg/m2), DCC was shorter, and with obesity (BMI > 30 kg/m2), it was longer than in people with normal body weight. At the same time, as body weight increases, the frequency of mixed (gastric and duodenal) reflux also rises up.
Conclusion. A comprehensive analysis of the characteristics of refluxate allows us to assess the course of the disease in more details, make assumptions about a unique combination of aggression factors for each patient, determine the severity of damage to the mucous membrane of the esophagus and, thanks to this, optimize approaches to therapy.
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##article.viewOnOriginalSite##About the authors
Igor V. Maev
Russian University of Medicine
Email: yurenev@list.ru
ORCID iD: 0000-0001-6114-564X
акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, MoscowGeorgy L. Yurenev
Russian University of Medicine
Author for correspondence.
Email: yurenev@list.ru
ORCID iD: 0000-0001-8181-8813
д-р мед. наук, проф. каф. пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, MoscowEkaterina M. Mironova
Russian University of Medicine; Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies
Email: yurenev@list.ru
ORCID iD: 0000-0003-2264-1047
аспирант каф. пропедевтики внутренних болезней и гастроэнтерологии; врач-гастроэнтеролог
Russian Federation, Moscow; MoscowReferences
- Eusebi LH, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018;67(3):430-40. doi: 10.1136/gutjnl-2016-313589
- Кляритская И.Л., Кривой В.В., Работягова Ю.С. Внепищеводные проявления гастроэзофагеальной рефлюксной болезни. Крымский терапевтический журнал. 2019;4:14-22 [Kliaritskaia IL, Kryvoy VV, Rabotyagova YuS. Extra-esophageal manifestations of gastroesophageal reflux disease. Krymskii terapevticheskii zhurnal. 2019;4:14-22 (in Russian)].
- Richter JE, Rubenstein JH. Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology. 2018;154(2):267-76. doi: 10.1053/j.gastro.2017.07.045
- Ивашкин В.Т., Маев И.В., Трухманов А.С., и др. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению гастроэзофагеальной рефлюксной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020;30(4):70-97 [Ivashkin VT, Maev IV, Truhmanov AS, et al. Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(4):70-97 (in Russian)]. doi: 10.22416/1382-4376-2020-30-4-70-97
- Ness-Jensen E, Hveem K, El-Serag H, et al. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176
- Katzka DA, Pandolfino JE, Kahrilas PJ. Phenotypes of Gastroesophageal Reflux Disease: Where Rome, Lyon, and Montreal Meet. Clin Gastroenterol Hepatol. 2020;18(4):767-76. doi: 10.1016/j.cgh.2019.07.015
- Roman S, Gyawali CP, Savarino E, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29(10):1-15. doi: 10.1111/nmo.13067
- Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351-62. doi: 10.1136/gutjnl-2017-314722
- Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361-71. doi: 10.1136/gutjnl-2023-330616
- Yadlapati R, Gyawali CP, Pandolfino JE, et al. AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review. Clin Gastroenterol Hepatol. 2022;20(5):984-94.e1. doi: 10.1016/j.cgh.2022.01.025
- Argüero J, Sifrim D. Pathophysiology of gastro-oesophageal reflux disease: implications for diagnosis and management. Nat Rev Gastroenterol Hepatol. 2024;21(4):282-93. doi: 10.1038/s41575-023-00883-z
- Shaqran TM, Ismaeel MM, Alnuaman AA, et al. Epidemiology, Causes, and Management of Gastro-esophageal Reflux Disease: A Systematic Review. Cureus. 2023;15(10):e47420. doi: 10.7759/cureus.47420
- Кляритская И.Л., Мошко Ю.А., Иськова И.А., Кривой В.В. ГЭРБ и ожирение, особенности клинического течения. Крымский терапевтический журнал. 2017;2:45-9 [Kliaritskaia IL, Moshko YuA, Iskova IA, Kryvoy VV. GERD and obesity, clinical features. Krymskij terapevticheskij zhurnal. 2017;2:45-9 (in Russian)].
- Kristo I, Paireder M, Jomrich G, et al. Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery. Obes Surg. 2020;30(12):4885-91. doi: 10.1007/s11695-020-04959-6
- Singh S, Sharma AN, Murad MH, et al. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11(11):1399-412.e7. doi: 10.1016/j.cgh.2013.05.009
- Kristo I, Paireder M, Jomrich G, et al. Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients. Obes Surg. 2019;29(11):3536-41. doi: 10.1007/s11695-019-04020-1
- Malkani N, Rashid MU. Systemic Diseases and Gastrointestinal Cancer Risk. J Cancer Allied Spec. 2023;9(2):473. doi: 10.37029/jcas.v9i2.473
- Yen HH, Tseng PH, Shih MC, et al. Derangement of esophageal anatomy and motility in morbidly obese patients: a prospective study based on high-resolution impedance manometry. Surg Obes Relat Dis. 2020;16(12):2006-15. doi: 10.1016/j.soard.2020.07.023
- Avvari RK. Theoretical modeling of the resistance to gastric emptying and duodenogastric reflux due to pyloric motility alone, presuming antral and duodenal quiescence. J Theor Biol. 2021;508:110460. doi: 10.1016/j.jtbi.2020.110460.
- Сторонова О.А., Трухманов А.С. 24-часовая рН-импедансометрия. Дифференциальный диагноз функциональных заболеваний пищевода. Пособие для врачей. Под ред. акад. РАН, проф. В.Т. Ивашкина. М.: МЕДПРАКТИКА-М, 2018 [Storonova OA, Trukhmanov AS. 24-chasovaya rN-impedansometria. Differentsialnyi diagnoz funktsionalnykh zabolevanii pishchevoda. Posobie dlia vrachei. Pod red. akad. RAN, prof. VT Ivashkina. Moscow: MEDPRAKTIKA-M, 2018 (in Russian)].
- Ивашкин В.Т., Маев И.В., Трухманов А.С., Румянцева Д.Е. Современные достижения в диагностике и лечении рефрактерной формы гастроэзофагеальной рефлюксной болезни. Терапевтический архив. 2018;90(8):4-12 [Ivashkin VT, Maev IV, Trukhmanov AS, Rumyantseva DE. Modern achievements in the diagnosis and treatment of the refractory gastroesophageal reflux disease Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(8):4-12 (in Russian)]. doi: 10.26442/terarkh20189084-12
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