Eduard Veseliny, Martin Janičko, Peter Jarčuška
The prevalence of obesity and gastroesophageal reflux disease (GERD) has increased substantially in the past 30 years. In obese individuals, the prevalence of GERD is considered substantially higher than in the general population. Obese patients tend to have more severe erosive esophagitis, and obesity is a risk factor for the development of Barrett’s oesophagus (BE) and adenocarcinoma of the oesophagus. GERD may have different causative factors in the obese compared with lean individuals. Visceral adipose tissue is metabolically active and secretes adipokines along with inflammatory cytokines that may predispose to complications of GERD such as BE and oesophageal carcinoma. Medical treatment with proton pump inhibitors is effective at treating GERD symptoms in the obese. Weight loss does improve GERD, but lifestyle modifications and diet are usually insufficient in the long-term for morbid obesity. Antireflux surgery in patients with elevated body mass index has been described with varied results. Bariatric procedures have also been evaluated for their effect on GERD, with laparoscopic gastric bypass offering the best results when compared with laparoscopic sleeve gastrectomy or laparoscopic adjustable gastric banding.