Even Small Weight Gains Up GERD Risk

Study found those of normal weight who put on a few pounds had more gastrointestinal problems

WEDNESDAY, May 31, 2006 (HealthDay News) -- Symptoms of gastroesophageal reflux disease (GERD) appear to be directly related to body-mass index, even if a person is not overweight.

"This sheds some light that any excess weight over ideal body weight may have a detrimental effect," said study author Dr. Brian Jacobson, an assistant professor of medicine at Boston University School of Medicine.

"Even if you were of normal weight and experienced a gain, you are more prone to reflux," added Dr. Anthony A. Starpoli, a gastroenterologist at Lenox Hill Hospital in New York City.

GERD occurs when the valve between the stomach and the esophagus fails to close properly. As a result, the contents in the stomach, including stomach acid, can spill up into the esophagus, leading to erosion of the esophagus and, in some cases, esophageal cancer.

Researchers have already established that overweight and obese people are at an increased risk for GERD, but there have been questions about the link between body-mass index (BMI) and GERD.

The authors of this study, which appears in the June 1 issue of the New England Journal of Medicine, wanted to look at a broader range of categories of BMI.

"Studies in the past have lumped together all normal-weight people," Jacobson explained. "We said, "Let's tease apart the normal weight as well.'"

The investigators asked randomly selected women participating in the Nurses' Health Study to fill out a supplemental questionnaire assessing the frequency, severity and duration of GERD symptoms.

Women were categorized according to BMI; BMI was then cross-referenced with symptom information.

Of 10,545 women who completed the questionnaire, 2,310 (22 percent) reported having symptoms at least once a week while 3,419 (55 percent of those who had any symptoms) described their symptoms as moderate in severity.

Women who had a BMI of less than 20 had a 33 percent lower chance of having GERD symptoms compared with women with a BMI of 20 to 22.4.

And compared to women with BMIs of 20 to 22.4, women with a BMI of 22.5 to 24.9 had a 38 percent higher risk of GERD symptoms. A BMI of more than 25 is considered overweight.

Even women who had a normal BMI at the start of the study but who saw an increase of more than 3.5 in their BMI had an increased risk of GERD symptoms.

"We see an extremely linear trend that shows that the higher up you go on the BMI scale, the higher risk you have," Jacobson said.

The study suggests that lower is better -- within reason.

"If you have heartburn and you're at your ideal body weight, I don't think anyone would suggest that you go to an unhealthy [low] weight," Jacobson said. "If you have put on a few pounds over the past few years and notice a few symptoms or your symptoms got worse, you may the have motivation to lose weight."

And given that excess weight is linked to a host of other ailments including heart disease, cancer and diabetes, you could be doing yourself a bigger favor than just ridding yourself of heartburn.

"Those conditions are all silent so people aren't all that motivated to lose weight," Jacobson said. "With heartburn, there's this annoying problem that's in your chest. It sort of redefines how you think of weight."

"Rip-roaring heartburn and regurgitation affects your quality of life immediately," Starpoli added. "We need to educate people that there are things that they can work on to avoid other problems such as cancer, diabetes and cardiovascular disease."

More information

For more on GERD, visit the National Digestive Diseases Information Clearinghouse.

SOURCES: Brian C. Jacobson M.D., assistant professor, medicine, Boston University School of Medicine; Anthony A. Starpoli, M.D., gastroenterologist, Lenox Hill Hospital, New York City; June 1, 2006, New England Journal of Medicine
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