The relationship, between obesity and Gastroesophageal Reflux Disease (GERD) has gained attention due to the rising rates of obesity. Alongside the increase in obesity there has been a surge in issues with GERD being one of the prominent conditions. Understanding the connection between obesity and GERD is crucial for comprehending their impact on health.
What is GERD?
GERD is a condition characterized by the flow of stomach acid into the esophagus leading to irritation, inflammation and various uncomfortable symptoms. Common signs of GERD include heartburn, regurgitation, chest pain and difficulty swallowing. If left untreated over time this condition can give rise to complications such as esophagitis, ulcers or even esophageal cancer over many years.
The Obesity Link
- Numerous studies have emphasized an association between obesity and GERD. Obesity increases the pressure inside the tummy, i.e obesity increases the intra-abdominal pressure. This pressure is then transmitted to the stomach causing the stomach contents which could be acid or food to flow in a reverse direction upwards into the food pipe (oesophagus). This leads to GERD/ Acid Reflux
- Additionally obesity can impact the functioning of the sphincter called the lower oesophageal sphincter (LES) which opens only to allow food and water to pass from the food pipe (oesophagus ) to the stomach. At all other times this LES remains closed preventing acid from entering the food pipe(oesophagus ). Due to obesity, this LES does not close completely and hence allows acid from the stomach to reflux into the food pipe (oesophagus ), thus causing GERD/ Acid Reflux
Mechanisms at Play
Several mechanisms contribute to explaining the connection, between obesity and GERD/ Acid Reflux
Increased Abdominal Pressure; Excessive weight, around the abdomen puts pressure on the stomach causing it to push acid up into the esophagus.
Changes in hormones; Fat tissue produces hormones and cytokines that can affect how the esophagus works and increase the risk of reflux.
Dietary factors; Obesity often goes hand in hand with food choices, such as consuming fat and acidic foods. These choices can worsen symptoms of GERD/ Acid Reflux.
Hiatus Hernia: Hiatus hernia is quiet common in the morbidly obese population and this also is a major contributing factor to the development of GERD/Acid Reflux in the obese.
Alcohol & Smoking: Both alcohol and smoking impact the function of the LES thus alcohol consumption and smoking in obese can further exacerbate the symptoms of GERD/ Acid Reflux
Managing both obesity and GERD requires an approach;
Weight management; Gradual weight loss achieved through a balanced diet and regular exercise can significantly improve symptoms of GERD in people who are obese.
Modifying your diet; Avoiding foods that trigger acid reflux, such, as fatty or acidic items can help reduce discomfort. Opting for small meals frequently throughout the day may also provide relief.
Lifestyle adjustments; Elevating the head of your bed while sleeping, avoiding lying down immediately after eating and maintaining an elevated posture while sleeping can assist in managing acid reflux.
Medical interventions; Proton pump inhibitor(PPI), Prokinetics, are medications that give very good results to relieve the symptoms of reflux.
Surgical options: This is the last resort when lifestyle and diet modifications fail, medications taken for long durations give short-term relief and reflux recures once medicines are stopped. The surgical options are:
- The Nissen’s Fundoplication: This procedure is preferred when GERD is not associated with Morbid obesity. In this procedure the upper part of the stomach is wrapped around the lower part of the food pipe(oesophagus) recreating the LES(lower oesophageal sphincter) which prevents reflux. This is a very helpful procedure which will give long term relief from GERD/Acid Reflux.
- Bariatric Surgery: The Roux-en-Y Gastric Bypass is one of the chosen options for people who are obese and having GERD. This procedure has a dual action. It not only trests GERD/Acid Reflux, but also helps to reduce weight in the Obese thus giving sure and long standing results for both obesity and GERD/Acid Reflux.
In conclusion
Obesity associated with GERD/Acid Reflux can impact a person’s lifestyle and day to day activity which could become very annoying. Recognizing how both these conditions are inter-related and need to be addressed together is very important. Treating GERD without addressing obesity will not give long lasting results. Hence, the importance of taking an approach to simultaneously manage obesity and GERD/Acid Reflux effectively is the right approach.
