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Obesity, HRT, and Reflux

This study reopens the issue of obesity as a risk factor for reflux symptoms and provides new evidence about the effects of HRT on this association.

Results of recent population-based studies have shown little or no association between increased body-mass index (BMI) and gastroesophageal reflux symptoms. Furthermore, data on an association between weight reduction and reflux have been mixed, and studies on this topic have been flawed by observational biases. In one investigation (Scand J Gastroenterol 2002; 37:626), researchers demonstrated a strong association between increased BMI and reflux esophagitis in women -- an association further strengthened in women who were using hormone-replacement therapy (HRT). To reexamine the relation between BMI and reflux symptoms and to determine HRT's effect on this association, the same group has now performed a population-based, cross-sectional, case-control study (among 3113 adults with and 39,872 without reflux symptoms) using Norwegian public health survey data from 1984-1986 and 1995-1997.

Reflux symptoms were significantly more common in severely obese (i.e., BMI >35) men and women than in normal-weight individuals (odds ratios, 3.3 for men and 6.3 for women). Among severely obese women, risk for reflux symptoms was significantly greater before than after menopause (ORs, 6.8 and 4.2, respectively); it was also greater for women who had ever used HRT than for those who had not (ORs, 16.0 and 5.5, respectively). The effect of HRT, independent of obesity, was not statistically significant. Weight loss during the interval between the 2 surveys reduced risk for reflux compared to no weight loss (OR, 0.6 with weight loss >3.5 BMI units).

Comment: This well-designed study reopens the issue of obesity as a risk factor for reflux symptoms and provides new evidence about the effects of HRT on this association. Although the authors carefully account for potential confounding effects (e.g., age, smoking, alcohol consumption), for some reason, they do not include use of reflux medications in their analysis. Also, it is extremely difficult to examine the independent effect of weight reduction without controlling for other related factors (e.g., diet, interaction with healthcare providers, physical-activity level). Hence, the results do not provide definitive answers about all aspects of the association between obesity and reflux symptoms.

— David A. Johnson, MD

Published in Journal Watch Gastroenterology July 29, 2003

Citation(s):

Nilsson M et al. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 2003 Jul 2; 290:66-72.

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