Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study - Obesity Surgery

Background

Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM.

Methods

Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry.

Results

A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m², and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m², were included. The proportions of patients reporting GERD-symptoms were low (< 29%) and did not differ significantly between groups, while the proportions of patients with esophagitis were high both in the T2DM and non-T2DM group, 58% versus 47%, p = 0.16. The majority of patients with esophagitis did not have GERD-symptoms (68–80%). Further, 55% of the patients with T2DM had pathologic acid reflux. Among these, 71% also had erosive esophagitis, whereof 67% were asymptomatic.

Conclusions

The prevalence of GERD was similar in bariatric patients with or without T2DM, and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2DM. Accordingly, GERD may be underdiagnosed in patients not undergoing a preoperative endoscopy or acid reflux assessment.

Trial Registration

Clinical Trials.gov number NCT01778738

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Author notes

1. Birgitte Seip and Jøran Hjelmesæth shared senior authorship and contributed equally to this work

Authors and Affiliations

1. Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway

   Jolanta Lorentzen, Jens Kristoffer Hertel, Heidi Borgeraas, Tor-Ivar Karlsen, Ronette L. Kolotkin, Rune Sandbu, Dag Hofsø & Jøran Hjelmesæth

2. Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway

   Jolanta Lorentzen, Dag Hofsø, Birgitte Seip & Jøran Hjelmesæth

3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

   Jolanta Lorentzen

4. Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway

   Asle W. Medhus

5. Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway

   Tor-Ivar Karlsen

6. Duke University School of Medicine, Durham, NC, USA

   Ronette L. Kolotkin

7. Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway

   Rune Sandbu & Marius Svanevik

8. Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

   Daniel Sifrim

9. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

   Marius Svanevik & Jøran Hjelmesæth

Corresponding author

Correspondence to Jolanta Lorentzen.

The study was registered in an international trial register (Clinical Trials. gov) https://clinicaltrials.gov/ct2/show/NCT01778738, and a protocol paper has been published previously [23].

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by the Regional Committees for Medical and Health Research Ethics in Norway (ref: 2012/1427/REK Sør-Øst B). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study.

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