title: Elevated body mass disrupts the barrier to gastroesophageal reflux; discussion 1018-9.
abstract: OBJECTIVE
  Obesity impairs the antireflux function of a structurally intact barrier.
  
  
  METHODS
  Retrospective analysis of body mass index in patients with normal esophageal manometric findings but with symptomatic and objectively confirmed gastroesophageal reflux.
  
  
  METHODS
  Specialist esophageal center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The barrier to gastroesophageal reflux is rendered insufficient in patients who are overweight.
authors.affiliation: Department of Surgery, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Wajed
authors.forename: C G
authors.initials: CG
authors.lastname: Streets
authors.forename: C G
authors.initials: CG
authors.lastname: Bremner
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies