Late Breaking News
Acid Reflux Therapy Works As Well In Obese Patients
KANSAS CITY, MO - Obesity is no barrier to effectiveness for proton pump inhibitors (PPI) in patients with gastroesophageal reflux disease (GERD), according to a VA database study
The study out of the Kansas City, MO, VAMC found that heartburn medications that block acid production in the gut are as effective for overweight and obese patients as for normal-weight patients.1
GERD is more common in obese and overweight patients, and results of past studies have been mixed on whether PPIs are as effective in that population. The new study, however, suggests that obesity appears to have no effect on outcomes from the therapy.
For the study, published online recently by the Journal of Clinical Gastroenterology, researchers examined data on more than 11,700 patients who had taken part in clinical trials. Treatment outcomes of patients with mild or a more erosive form of GERD — all of whom had used PPIs — were compared based on their body mass indexes (BMI).
One analysis included 704 patients with non-erosive reflux disease (NERD) receiving esomeprazole 20 mg, esomeprazole 40 mg, or placebo. A second analysis included 11,027 patients with erosive esophagitis (EE) receiving esomeprazole 40 mg, omeprazole 20 mg, or lansoprazole 30 mg.
While higher BMI was associated with more severe GERD at baseline, according to the analysis, it was not associated with better or worse outcomes during drug treatment.
“For NERD patients, no significant association between baseline heartburn severity and body mass index was observed,” according to the report. In fact, proton pump inhibitors resolved heartburn in about a third of those with the milder form of GERD, regardless of BMI.
The authors noted thatoverweight (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), yet 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 vs. women (all P<=0.0284), according to the results. EE healing, meanwhile, 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).
“In patients with GERD, high BMI was associated with more severe EE at baseline,” the authors concluded. “However, during PPI treatment, BMI is not a significant independent predictor of heartburn resolution or EE healing.”
1. Sharma P, Vakil N, Monyak JT, Silberg DG. Obesity Does Not Affect Treatment Outcomes With Proton Pump Inhibitors. J Clin Gastroenterol. 2013 Feb 24. [Epub ahead of print] PubMed PMID: 23442835.