Association of obesity with hiatal hernia and esophagitis

OBJECTIVE: Although weight loss is commonly recommended for symptoms of gas troesophageal reflux, a relationship between excessive body weight and esop hageal reflux has not been established. The aim of this study was to determ ine whether obesity is associated with the presence of a hiatal hernia (HH) and/or an endoscopic diagnosis of esophagitis. METHODS: Retrospective case control studies were done using 1389 patients w ho underwent gastric analysis and upper GI endoscopy between 1974 and 1995. After excluding patients with Zollinger-Ellison syndrome, 189 cases of eso phagitis with 1024 controls were identified. In a separate analysis of the database, 151 cases of HH with 1053 controls were also identified. Patients were classified by body mass index (BMI) as: thin (BMI <20 kg/m(2)), norma l (BMI 20-25), mildly obese (BMI 25-30), and obese(BMI >30). RESULTS: Excessive body weight was significantly associated with the presen ce of HH, the probability of HH increasing with each level of BMI (p < 0.01 ),as well as with esophagitis (OR 1.8; 95% CI 1.4-2.1). HH was independentl y associated with esophagitis (OR 4.2 95% CI 2.4-6.1); when controlled for the effect of HH, the association between BMI and esophagitis diminished bu t remained significant. In the population as a whole, for the presence of e sophagitis multiple logistic regression indicates BMT and hiatal hernia wer e significant factors bur gender and race did not appear to be. CONCLUSIONS: Excessive body weight is a significant independent risk factor for hiatal hernia and is significantly associated with esophagitis, largel y through an increased incidence of hiatal hernia. Whites are more likely t o have the combination of esophagitis and hiatal hernia than are blacks. (C ) 1999 by Am. Cell. of Gastroenterology.