Obesity and Esophageal Disorders

Obesity and Esophageal Disorders is a comprehensive review on the impact of obesity on esophageal disorders and how to approach, recognize and treat those disorders. Covering the critical gap in awareness on the impact of obesity on esophageal disorders, this reference presents the newest diagnostic technologies, including high resolution manometry, EndoFLIP, wireless pH monitoring, and mucosal integrity devices. The book shows treatment options like bariatric surgery and endo-bariatrics that decrease the latency period for diagnosis and management of patients. Finally, the understanding of the potential effects of different bariatric surgeries on esophageal motility is explored.

This importance reference serves researchers looking to determine future projects by providing novel pathophysiologic mechanisms about how obesity affects GERD and esophageal motility. It serves clinicians, surgeons and trainees with guidance on diagnostic approaches, management options, and how to recognize/treat post-surgical esophageal complications of patients with obesity.

• Delivers an overview of the impact of obesity on esophageal disorders
• Probes the evidence behind current dietary, lifestyle, medical, endo-bariatric and surgical bariatric treatment options
• Provides a comprehensive review of the impact of post-bariatric surgery on GERD and esophageal motility

• Language: English
• Publisher: Academic Press
• Release date: Jun 25, 2022
• ISBN: 9780323985727

Book preview

Preface

Dhyanesh A. Patel, Robert Kavitt, Shabnam Sarker and Michael Vaezi

It is our great pleasure to introduce you to an issue of Obesity and Esophageal Disorders.

Obesity is commonly encountered in our medical practice and is linked to numerous comorbidities along with severe impairment of overall health. According to the National Institute of Health, two of three patients are either overweight or obese. The WHO has found that over 650 million patients are affected by obesity and nearly 2 billion who are overweight. Thus obesity is a growing medical and public health problem worldwide with a staggering $147 billion in medical costs. Overweight and obesity are well-known risk factors for a variety of gastrointestinal disorders but have directly contributed to an exponentially rising incidence of gastroesophageal reflux disease (GERD) with a recent study showing that reflux symptoms affect one in three Americans. This has also affected the incidence of long-term complications of GERD including esophageal dysmotility, Barrett’s esophagus, and esophageal cancer. There is a critical gap in awareness about impact of obesity on esophageal disorders and medical provider’s ability to provide timely diagnosis and management.

The field of esophageal diseases has been transformed over the last decade with the advent of newer diagnostic technologies (high-resolution manometry and functional luminal imaging probe for motility disorders; wireless pH monitoring; and mucosal integrity devices for GERD) and treatment options (bariatric surgery, endobariatrics, and medical) that decrease the latency period for diagnosis and management of these patients. Furthermore, as surgical management of obesity is increasing in prevalence, we are also now starting to understand the potential effects of different bariatric surgeries on esophageal motility.

This book is the first comprehensive, state-of-the art review on impact of obesity on various esophageal disorders and how to approach, recognize, and treat those disorders. This book will serve as a valuable resource for clinicians, surgeons, researchers, and trainees with an interest in the management of patients with obesity. The book provides an exhaustive literature review of all the current evidence behind diagnosis, evaluation, and management of various obesity-related esophageal disorders written by the most prominent clinicians and researchers in this field.

The chapters are organized so that the readers systematically learn about prevalence of obesity and impact on gastrointestinal health in both adults and pediatric population followed by impact on GERD and Barrett’s esophagus. We subsequently review how obesity and bariatric surgery can affect esophageal motility and discuss diagnostic tools. Lastly, we include nonsurgical, endoscopic, and surgical therapeutic options in patients with obesity and esophageal disorders. We are grateful to the contributors and hope that the book provides insight into an evidence-based approach to taking care of this patient population.

Chapter 1

Obesity and its impact on gastrointestinal health

Shakirat Salvador, Adesola Oje and Shabnam Sarker,    Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, United States

Abstract

Obesity is a complex disease that can predispose to metabolic derangements that can lead to multiorgan dysfunction. This chapter will review the epidemiology of obesity, describe the economic burden of disease, and review the complex association between metabolic syndrome and its role in gastrointestinal diseases. Finally, the impact of obesity on the pediatric population will be discussed.

Keywords

Esophagus; epidemiology; gastrointestinal diseases; metabolic syndrome; obesity; pediatric population

Overview

Obesity is a complex disease that can predispose to metabolic derangements that can lead to multiorgan dysfunction. This chapter will review the epidemiology of obesity, describe the economic burden of disease, and review the complex association between metabolic syndrome and its role in gastrointestinal diseases. Finally, the impact of obesity on the pediatric population will be discussed.

Introduction

Obesity is defined as a body mass index (BMI) of greater than or equal to 30, with further subgroup classifications defined by the World Health Organization (WHO). Class I obesity is defined as a BMI between 30 and 34.9. Class II obesity is defined as BMI between 35 through 39.9, and Class III obesity is defined as BMI greater than or equal to 40.¹ Obesity leads to metabolic neurohormonal disarray that leads to alterations in lipid metabolism and lipid resistance. The metabolic syndrome is characterized by increased waist circumference, dyslipidemia, hypertension, and hyperglycemia.² This is exceedingly recognized in other metabolic conditions such as diabetes, cardiovascular disease, cerebrovascular disease, and malignancies. Other disease associations include obstructive sleep apnea and polycystic ovarian syndrome. In essence, metabolic syndrome describes a complex interplay of metabolic derangements with established comorbid conditions.²

The effects of obesity and its relationship with gastrointestinal and hepatologic conditions continue to evolve. This becomes particularly evident in conditions such as gastroesophageal reflux disease, dyspepsia, nonalcoholic fatty liver disease, small intestinal bacterial overgrowth, diverticulosis, and pancreatitis.²

Epidemiology

The international prevalence of obesity continues to rise. According to the WHO, the current worldwide prevalence of obesity is almost triple that of 1975. In 2016, approximately 1.9 billion (39%) adults aged 18 and older were overweight, while 650 million (19%) of this cohort were obese. In this population, 39% were men while 40% were women.³ Currently, it is estimated that 39%–49% of the global population is either obese or overweight.⁴ Across all countries, the prevalence of obesity among women has been on the rise. In the 1970s, data looking at the overall global trend of obesity showed a prevalence of greater than 5% but less than 20% of women in developed nations.⁵

According to the United States Center for Disease Control, the prevalence of obesity within the United States was 42.4% with a projected increase to up to 48.9% by the year 2030. The most recent data published in 2020 by the National Center for Health Statistics highlight this trend. Between 2017 and 2018, 42.4% of the adult population was noted to be obese. Data for various ethnic groups consistently demonstrate that Non-Hispanic Black Americans had the highest prevalence of obesity 49.6% when compared to non-Hispanic Asians 17.5%, non-Hispanic Caucasians 42.2%, and 44.8% in Hispanics.⁶ These numbers are largely impacted by racial disparities, stigmatization of weight, and psychosocial stressors, as well as factors that exacerbate socioeconomic inequalities.⁷

Fig. 1.1 shows an illustrated representation of the percent of adults in the United States who have obesity in the year 2020 based on data compiled by the Center for Disease Control using the Behavioral Risk Factor Surveillance System.⁸

Figure 1.1 Percent of adults in the United States who have obesity in the year 2020 based on data compiled by the Center for Disease Control using the Behavioral Risk Factor Surveillance System.⁸ Created wih BioRender.com.

Medical Complications

As the burden of disease increases, there have been multiple efforts to understand the effects of obesity and its contributions to metabolic alterations and organ dysfunction. Excess weight and obesity are known risk factors for several chronic medical conditions including cardiovascular disease, diabetes mellitus, chronic kidney disease, malignancies, musculoskeletal diseases, stroke, dementia, nonalcoholic fatty liver disease, and obstructive sleep apnea.⁹ Fig. 1.2 shows an illustrated representation of the organs and associated disorders linked to obesity.

Figure 1.2 End organ damage due to obesity. Created with BioRender.com.

Several studies have highlighted the impact of obesity on the cardiovascular system. The Global Burden of Disease in 2015 showed that people with high BMI accounted for 4.0 million deaths in 2015 with greater than 2/3 secondary to cardiovascular disease even after accounting for critical illness and tobacco use.¹,¹⁰ Globally, cardiovascular disease is the leading cause of death in the overweight and obese population accounting for 2.7 million deaths (95% CI: 1.8–3.7) and 66.3 million disability-adjusted life years (95% CI: 45.3–88.5). As a result, there are currently several studies assessing the impact of weight loss and lifestyle modification on cardiovascular outcomes. The Look Action for Health in Diabetes (AHEAD) was a multicenter randomized controlled trial conducted between 2001 and 2012 to determine the impact weight loss had on cardiovascular morbidity and mortality in patients with T2DM (the Look Ahead Research Group).¹¹ Although results failed to show a reduction in Major Adverse Cardiovascular Events (MACE) or cardiovascular mortality after 9.61 years, post-hoc analysis showed that patients with ≥10% weight loss had significant reductions in cardiac events.¹¹

Physical exercise, particularly aerobic exercise, and pharmacologic interventions such as the glucagon-like peptide 1 agonists have been shown to reduce MACE.¹²

Obesity and Pharmacokinetics

Obesity also impacts drug pharmacokinetics, especially those of lipophilic medications.¹³ While oral absorption is not affected, the distribution and clearance of certain drugs are affected. Each medication presents a unique challenge as its affinity for adipose tissue is unique.¹³ This requires closer monitoring of such medication in obese patients and can present challenges in reaching appropriate dosing.

Economic Burden of Obesity

Obesity poses an economic burden not only to individuals and families but nations as well. The costs incurred by obesity are either direct, those associated with medical services (e.g., the value of lost work, insurance costs, wages), or indirect, costs due to resources