~ Gastroesophageal Reflux Disease - Even Small Weight Gains Increase Risk

New York Times Syndicate, 06-02-06

Symptoms of gastroesophageal reflux disease 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," says 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," adds Dr. Anthony A. Starpoli, a gastroenterologist at Lenox Hill Hospital in New York City.

Gastroesophageal reflux disease 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 gastroesophageal reflux disease, but there have been questions about the link between body-mass index and gastroesophageal reflux disease.

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 explains. "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 gastroesophageal reflux disease 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 gastroesophageal reflux disease 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 gastroesophageal reflux disease 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 gastroesophageal reflux disease 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 says.

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 says. "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 says. "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 adds. "We need to educate people that there are things they can work on to avoid other problems such as cancer, diabetes and cardiovascular disease."

(The HealthDay Web site can be viewed at www.HealthDay.com.)

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