Body Mass Index Has No Effect On Resolution, Healing Of GERD Symptoms

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Gastroesophageal Reflux Disease

The link between gastroesophageal reflux disease (GERD) and obesity has long been established, but healthcare professionals have had little guidance as to whether obese patients with GERD should be treated differently than normal-weight patients with GERD. Two studies about obesity and its relationship to GERD were presented at the American College of Gastroenterology (ACG) Annual Scientific Meeting this week.

One study, which evaluated symptom resolution in patients with non-erosive reflux disease, a type of GERD, received a 2007 ACG Presidential Poster Award. The other study examined GERD patients with erosive esophagitis, a condition in which stomach acid wears away, or erodes, the inner lining of the esophagus over time. Results of both studies showed despite whether a patient with GERD is considered obese or not, treatment should remain the same.

Body Mass Index (BMI) measures body fat by comparing a person's height to weight. A person with a BMI greater than 30 kg/m is considered obese. GERD is characterized by frequent, persistent heartburn (a burning feeling, rising from the stomach or lower part of the chest towards the neck) two or more days a week. It occurs when the valve between the esophagus and stomach does not close properly, allowing acid to leak back into the esophagus. When a person is overweight or obese, pressure inside the abdomen may increase causing this valve to relax, often leading to acid reflux. In fact, studies have shown that people with a BMI greater than 30 kg/m -- the cutoff for obesity -- face double the risk of developing GERD.

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"With obesity on the rise and more patients at risk for GERD than ever before, it's especially important that we understand how to treat overweight patients with GERD," said Prateek Sharma, MD, FACG, University of Kansas School of Medicine, an author for both analyses. "These analyses show that obese patients with GERD can probably follow the same treatment protocol as patients with GERD who are not overweight, with the same anticipated outcomes."

In the first study, data from two randomized, double-blind trials comparing NEXIUM (esomeprazole magnesium) 20 mg or 40 mg once daily with placebo were pooled and analyzed. A total of 704 patients with non-erosive reflux disease -- meaning they had frequent heartburn but no evidence of erosion in the esophagus -- were included. The analysis showed that BMI had no significant effect on resolution of heartburn (P=0.9853) in patients treated with NEXIUM.

The second study looked at a total of 11,027 GERD patients with erosive esophagitis, a condition in which stomach acid wears away, or erodes, the inner lining of the esophagus over time. About one in three people with frequent, persistent heartburn also have erosive esophagitis. Researchers analyzed five randomized, double-blind multicenter clinical studies that compared NEXIUM 40 mg once daily with omeprazole 20 mg once daily or lansoprazole 30 mg once daily. The analysis found that BMI had no significant effect on healing of erosions (P=0.2286) in patients treated with PPIs.

"PPIs are the mainstay of therapy for patients with erosive and non-erosive GERD. These analyses tell us that the dosage of NEXIUM, one of the most well-studied PPIs, remains equally as effective regardless of a patient's weight, and does not need to be adjusted based on a patient's BMI-an ideal quality for any medication," said Debra Silberg MD, PhD, Senior Director Clinical Research at AstraZeneca and an author on both of the studies.

Dr. Silberg added that while these studies confirm that PPIs are effective therapies for GERD patients who are overweight or obese, losing weight through a healthy diet and regular exercise may also help alleviate symptoms.

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