Elevated body mass disrupts the barrier to gastroesophageal reflux; discussion 1018-9.

HYPOTHESIS Obesity impairs the antireflux function of a structurally intact barrier. DESIGN Retrospective analysis of body mass index in patients with normal esophageal manometric findings but with symptomatic and objectively confirmed gastroesophageal reflux. SETTING Specialist esophageal center. PATIENTS Patients symptomatic and diagnostic for gastroesophageal reflux, referred between October 1, 1998, and June 30, 2000. Exclusion criteria were a defective barrier, motility disorders, or previous surgery. MAIN OUTCOME MEASURES Reflux was defined and quantified using the DeMeester score, and body mass index was calculated. RESULTS There was a strong correlation between body mass index and severity of gastroesophageal reflux. Patients who were overweight had significantly higher distal esophageal acid exposure. No significant difference in manometric findings was demonstrated between patients with normal weight and those who were overweight. CONCLUSION The barrier to gastroesophageal reflux is rendered insufficient in patients who are overweight.