Recently, Dr. Darido, MD, became a Contributing Editor in the MD News magazine. His first article is based upon the increasing rise of GERD. Darido mentions, “today, around one-third of all Americans experience a GERD-related symptom at least once weekly. Esophageal adenocarcinoma, a complication of GERD, is the fastest growing cancer in the U.S. Abdominal girth and excess weight contribute to GERD.”
There have been many studies Darido goes on to mention, on the link between BMI and GERD, and that “obesity may promote the development of GERD.” The question Darido proposes is, if obesity has an association with GERD, “what would be the underlying mechanisms?”
Based on studies, the association between obesity and GERD comes from the relation of increased intra-abdominal pressure secondary to abdominal fat accumulation. Darido goes on to mention how this process works, “Intra-gastric pressure increases, promoting a backflow of gastric content into the esophagus. Several studies have shown that GERD patients’ increasing BMI is independently associated with increased intra-gastric pressure.” As simple as this sounds, this is only the basis of complex problem. There are three components making up the gastroesophageal junction (GEJ), which is the foundation of GERD pathogenesis. The diaphragmatic crura is made up of:
- Lower esophageal sphincter
- The surrounding crural diaphragm: the angle of the Hiss – where the intra-abdominal esophagus joins the stomach).
- Phrenoesophageal membrane (PEM)
Together these three components work together to prevent acid reflux. Dr. Darido goes on to discuss bariatric surgery as an option for weight loss to help ease acid reflux. However, a recent study showed “resolution of symptomatic GERD following sleeve gastrectomy in morbidly obese patients.” Could this be another option?
The future will bring new treatments and procedures, as GERD continues to rise. Read the full article here.