Positive correlation between abnormal upper endoscopy findings and increasing BMI

Kim HJ et al. (2007) Influence of overweight and obesity on upper endoscopic findings. J Gastroenterol Hepatol 22: 477–481

As BMI increases, so does the incidence of GERD and upper and lower gastrointestinal symptoms, such as vomiting, upper abdominal pain, bloating and diarrhea. In the first study of its kind, the hypothesis that abnormal upper endoscopic findings indicative of mucosal damage are more prevalent in overweight (BMI ≥25 kg/m² to <30 kg/m²) or obese (BMI ≥30 kg/m²) patients than in normal weight patients (BMI ≥18.5 kg/m² to <25 kg/m²) has been investigated.

Kim et al. grouped the data generated from 27,319 patients who had undergone esophagogastroduodenoscopy according to their upper endoscopy findings and BMI. The cohort excluded patients who had undergone esophagogastric surgery, taken medications that might affect the gastrointestinal mucosa (e.g. NSAIDs, PPIs) in the previous month, undergone H. pylori eradication or had a history of Zollinger–Ellison syndrome. Statistical analysis revealed that group 1 (erosive gastritis, gastric ulcer and duodenal ulcer) and group 2 (reflux esophagitis) findings were more prevalent in overweight and obese patients compared with normal weight patients, when adjusted for age, sex and tobacco and alcohol use.

The authors acknowledge that psychosomatic symptoms were not assessed and that surreptitious drug use might have influenced the results. Nevertheless, they conclude that a positive linear correlation exists between the prevalence of abnormal upper endoscopic findings and increasing BMI.

Further studies are needed to investigate the causal relationship between eating habits (a key contributor to obesity), impaired gastrointestinal function and anatomical changes in the upper gastrointestinal mucosa.