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Obesity Does Not Affect Treatment Outcomes With Proton Pump Inhibitors

Sharma, Prateek MD*; Vakil, Nimish MD; Monyak, John T. PhD; Silberg, Debra G. MD, PhD

Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0b013e31827e46be
ALIMENTARY TRACT: Original Articles
Abstract

Background: Obesity is associated with increased risk of gastroesophageal reflux disease (GERD).

Goal: To evaluate the effect of obesity on symptom resolution in patients with nonerosive reflux disease (NERD) and healing rates in patients with erosive esophagitis (EE).

Methods: Two post hoc analyses were performed. Analyses included pooled data from randomized, double-blind, multicenter studies of proton pump inhibitors (PPIs) in GERD patients.

Results: Analysis 1 included 704 patients with NERD receiving esomeprazole 20 mg, esomeprazole 40 mg, or placebo. Analysis 2 included 11,027 patients with EE receiving esomeprazole 40 mg, omeprazole 20 mg, or lansoprazole 30 mg. For NERD patients, no significant association between baseline heartburn severity and body mass index (BMI) was observed. In EE patients, overweight (BMI 25 to <35 kg/m2) and obese (BMI ≥35 kg/m2) patients had significantly higher rates of Los Angeles (LA) grade C or D EE than patients with BMI <25 kg/m2 (P<0.0001). Percentages of PPI-treated patients who achieved heartburn resolution or EE healing within a given LA grade were similar across BMI categories. Heartburn resolution was significantly associated with treatment (esomeprazole vs. placebo), increasing age, and for men versus women (all P≤0.0284). EE healing was significantly associated with PPI treatment (esomeprazole and lansoprazole vs. omeprazole), increasing age, race, presence of a hiatal hernia, and lower LA grade at baseline (all P≤0.0183).

Conclusions: In patients with GERD, high BMI was associated with more severe EE at baseline. However, during PPI treatment, BMI is not a significant independent predictor of heartburn resolution or EE healing.

Author Information

*Department of Gastroenterology, Veterans Affairs Medical Center, University of Kansas School of Medicine, Kansas City, MO

University of Wisconsin Medical School, Madison, WI

AstraZeneca LP, Wilmington, DE

Present address: Debra G. Silberg, MD, PhD, Shire Pharmaceuticals, Philadelphia, PA.

P.S. has made substantial contributions to the conception and design and the analysis and interpretation of data, has been involved in drafting and revising the manuscript critically for important intellectual content and has given final approval of the version to be published. N.V. has made substantial contributions to the conception and design and the analysis and interpretation of data, has been involved in drafting and revising the manuscript critically for important intellectual content, and has given final approval of the version to be published. J.T.M. has made substantial contributions to the acquisition of and the analysis and interpretation of data, has been involved in drafting and revising the manuscript critically for important intellectual content and has given final approval of the version to be published. D.G.S. has made substantial contributions to the conception and design and the analysis and interpretation of data, has been involved in drafting and revising the manuscript critically for important intellectual content, and has given final approval of the version to be published.

Supported by AstraZeneca LP, Wilmington, DE. Medical writing and editorial services were provided by Marie Bialek (freelance writer), Sarita Shaevitz, PhD, of Scientific Connexions, Newtown, PA, and Lisa M. Klumpp Callan, PhD (formerly of Scientific Connexions), on behalf of AstraZeneca LP.

P.S. receives research funding from Barrx Medical, Mauna Kea Technologies, Olympus, and Takeda. N.V. serves as a consultant for AstraZeneca, Orexo, Takeda, Salix, Axcan, Novartis, Aryx, Xenoport, Gerson Lehman Group, Guidepoint Global, and Shire and receives research funding from Xenoport, Addex, and AstraZeneca. He owns stocks of Orexo and Meridian. J.T.M. is an employee of AstraZeneca. D.G.S. was an employee of AstraZeneca at the time this manuscript was written and currently is an employee of Shire Pharmaceuticals.

Reprints: Prateek Sharma, MD, Department of Gastroenterology, Veterans Affairs Medical Center, University of Kansas School of Medicine, Mail Stop 4801 East Linwood Boulevard, Kansas City, MO 64128 (e-mail: psharma@kumc.edu).

Received August 9, 2012

Accepted November 15, 2012

© 2013 by Lippincott Williams & Wilkins