RISK FACTORS ASSOCIATED WITH UNDESIRED BMI INCREASE IN GERD PATIENTS

Background and aim: Obesity is a multifactorial disease and is recognized as a risk factor for gastrooesophageal reflux disease (GERD). Recent data showing that long term PPI therapy is associated with weight gain, indirectly suggest that GERD may, per se, affect body weight. We aimed to examine the contribution of factors other than GERD on body weight changes. Material and methods: We studied 184 consecutive patients (63 male, age 46 ± 13 years) with clinical and instrumental (endoscopy and 24h pHmetry) diagnosis of GERD. At baseline BMI was recorded and GERD symptoms were scored. Coexistence of diabetes, hypertriglyceridemia, hypertension and hypercholesterolemia were also recorded. All patients were treated with stan- dard dosage of PPIs for 6 weeks and advised on lifestyle modifications, but not on selective diet, or weight management, and followed up to 1 years. In case of symptoms recurrence, patients were also instructed to reintroduce PPIs therapy on an demand regimen. BMI, persistence of GERD symptoms and needing for PPI therapy were recorded at the follow-up. Data were analysed by considering the effect of all of the variables on BMI changes ( < or > 5% respect to baseline BMI) at the end of follow up. Patients were divided in normal weight, overweight or obese according to internationally accepted BMI values. Results: Averaged BMI values were unchanged at the end of the follow up (26 ± 5vs.26 ± 5). Similarly, patients with normal weight, overweight and obesity were respectively 37, 46 and 17% vs. 37, 44 and 19%. No significant differences in terms of demographic factors, persistence of GERD symptoms and needing of PPI therapy were found in patients with either BMI decrease or increase, respectively. When all variables were computed in a multivariate analysis, only pre-existing normal weight (OR 2.6, 95% CI 1-6.7, p=0.03) and diabetes (OR 5, 95%CI 1-18, p=0.007) were significantly associated to the risk of increased BMI. Conversely, only obesity (OR 5, 6%CI 1.7-19, p=0.005) was a risk factor associated with reduced BMI. Conclusions: Other factors rather than symptoms persistence and PPI therapy are associated with BMI changes in a population of GERD patients. The finding that baseline normal weight and diabetes are associated with undesired weight increase suggests an accurate screening to avoid BMI increase in this subset of GERD patients.