Original Contribution

Esophagus

The Reflux Improvement and Monitoring (TRIM) Program Is Associated With Symptom Improvement and Weight Reduction for Patients With Obesity and Gastroesophageal Reflux Disease

  • The American Journal of Gastroenterology volume 113, pages 2330 (2018)
  • doi:10.1038/ajg.2017.262
  • Download Citation
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Subjects

Abstract

Objectives:

Current healthcare systems do not effectively promote weight reduction in patients with obesity and gastroesophageal reflux disease (GERD). The Reflux Improvement and Monitoring (TRIM) program provides personalized, multidisciplinary, health education and monitoring over 6 months. In this study we aimed to (i) measure the effectiveness of TRIM on GERD symptoms, quality of life, and weight, and (ii) examine patient health beliefs related to TRIM.

Methods:

This prospective mixed methods feasibility study was performed at a single center between September 2015 and February 2017, and included adult patients with GERD and a body mass index ≥30 kg/m2. Quantitative analysis consisted of a pre- to post-intervention analysis of TRIM participants (+TRIM Cohort) and a multivariable longitudinal mixed model analysis of +TRIM vs. patients who declined TRIM (−TRIM Cohort). Primary outcomes were change in patient-reported GERD symptom severity (GerdQ) and quality of life (GerdQ-DI), and change in percent excess body weight (%EBW). Qualitative analysis was based on two focus groups of TRIM participants.

Results:

Among the +TRIM cohort (n=52), mean baseline GerdQ scores (8.7±2.9) decreased at 3 months (7.5±2.2; P<0.01) and 6 months (7.4±1.9; P=0.02). Mean GerdQ-DI scores decreased, but did not reach statistical significance. Compared with the −TRIM cohort (n=89), reduction in %EBW was significantly greater at 3, 6, and 12 months among the +TRIM cohort (n=52). In qualitative analysis, patients unanimously appreciated the multidisciplinary approach and utilized weight loss effectively to improve GERD symptoms.

Conclusions:

In this mixed methods feasibility study, participation in TRIM was associated with symptom improvement, weight reduction, and patient engagement.

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Author information

Affiliations

  1. University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

    • Rena Yadlapati
    • , John E Pandolfino
    • , Olga Alexeeva
    • , Dyanna L Gregory
    • , Meredith R Craven
    • , Erin Seger
    •  & Moira Workman
  2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    • John E Pandolfino
    • , Olga Alexeeva
    • , Dyanna L Gregory
    • , Meredith R Craven
    • , Abbey Lichten
    • , Erin Seger
    • , Moira Workman
    • , Nora St. Peter
    • , Jenna Craft
    • , Bethany Doerfler
    •  & Rajesh N Keswani
  3. University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA

    • David Liebovitz

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Competing interests

Guarantor of the article: Rena Yadlapati, MD, MSHS

Specific author contributions: R.Y.: study oversight, study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript; J.E.P.: study concept and design, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript; O.A.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript; D.L.G.: study concept and design, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript; M.R.C.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript; D.L.: study concept and design, critical revision of the manuscript for important intellectual content, and finalization of manuscript; A.L.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, and finalization of manuscript; E.S.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, and finalization of manuscript; M.W.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, and finalization of manuscript; N.S.P.: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, and finalization of manuscript; J.C.: study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and finalization of manuscript; B.D.: study concept and design, critical revision of the manuscript for important intellectual content; and finalization of manuscript; R.N.K.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and finalization of manuscript.

Financial support: R.Y. was supported by NIH T32DK101363. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Potential competing interests: None.

Corresponding author

Correspondence to Rena Yadlapati.

Supplementary information

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg