Features of the phenotypic manifestations of GERD in its comorbidity with obesity

To optimize the algorithm of diagnosis and treatment of patients with gastroesophageal reflux disease (GERD) with comorbid obesity based on a comprehensive analysis of the clinical and functional characteristics of the disease. The study included 150 patients who underwent esophagogastroduodenoscopy, 24-hour pH-measurement or 24-hour pH-impedancometry of the esophagus. A stratification was carried out basing on the presence of typical GERD complaints and body mass index (BMI). Group 1 consisted of 30 patients with GERD and normal body weight; group 2 - 60 patients with GERD who were overweight or obese; group 3 - 30 patients without GERD, but overweight or obese; control group - 30 people with normal body weight without GERD, but with similar complaints due to functional disorders of the esophagus. When comparing esophageal pH-impedancometry data, it was found that the volume clearance time did not differ between the groups of patients with normal body weight and overweight, but in obese people reflux with pH > 7 was recorded more often and for a longer time. The duration of chemical clearance (DCC) was increased in both groups, however, with overweight (BMI > 25 kg/m2), DCC was shorter, and with obesity (BMI > 30 kg/m2), it was longer than in people with normal body weight. At the same time, as body weight increases, the frequency of mixed (gastric and duodenal) reflux also rises up. A comprehensive analysis of the characteristics of refluxate allows us to assess the course of the disease in more details, make assumptions about a unique combination of aggression factors for each patient, determine the severity of damage to the mucous membrane of the esophagus and, thanks to this, optimize approaches to therapy.