Obesity and Esophageal Dysfunction

Obesity and related comorbidities are on the rise, with trends showing that nearly half of the United States population will be obese by 2030. This review focuses on the pathophysiology of esophageal disorders in patients with obesity as well as treatment considerations for obesity in patients with esophageal disorders.

Gastroesophageal reflux disease (GERD) is prevalent in approximately 20% of patients with obesity and is associated with multiple underlying anatomic risk factors. In addition, systemic and paracrine proinflammatory effects mediated by visceral adipose tissue also contribute to the development of GERD-related complications such as erosive esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. Esophageal dysmotility is also common in obesity, although with varying clinical impact as the majority of patients are asymptomatic. Although data regarding laparoscopic sleeve gastrectomy and GERD is conflicting, Roux-en-Y gastric bypass is considered the preferred surgical approach for obesity in patients with GERD. Recent data signal that newer anti-obesity medications like glucagon-like peptide 1 (GLP-1) agonists may lead to increased GERD and related complications; however, data on this subject is limited.

Esophageal dysfunction is prevalent in patients with obesity and should be carefully evaluated prior to considering treatment for obesity such as bariatric surgery or antiobesity medications.