title: Gastroesophageal reflux disease is inversely related with glycemic control in morbidly obese patients.
abstract: BACKGROUND
  The link between diabetes mellitus and gastroesophageal reflux disease (GERD) is controversial. We assessed the relationship between glycemic control (GC) and GERD in morbidly obese patients.
  
  
  METHODS
  Consecutive patients with morbid obesity (n = 86) underwent manometry, pH-metry, endoscopy, and contrasted X-ray after responding to a GERD questionnaire and dosing fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Patients with poor GC (HbA1c, 6.1-10% and FPG < 140 mg/dl) and those with very poor GC (HbA1c > 10% or FPG > 140 mg/dl) were compared.
  
  
  RESULTS
  There were 63 patients with poor GC and 17 with very poor GC. Compared to patients with very poor GC, patients with poor GC showed higher heartburn scores [8 (0-12) vs. 0 (0-4); P = 0.003]; higher total esophageal acid exposure [5.2% (2.5-10.5%) vs. 2.3% (0.8-7.5%); P = 0.041]; lower distal esophageal amplitude (105 ± 38 vs. 134 ± 63 mmHg; P = 0.019); higher expiratory gastroesophageal pressure gradient (GEPG, 7 ± 3.4 vs. 5.2 ± 3 mmHg; P = 0.050); lower ventilatory gradient (inspiratory-expiratory GEPG, 10.9 ± 3.8 vs. 13.6 ± 4.1 mmHg; P = 0.012); lower waist-to-hip ratio (0.95 vs. 1; P = 0.040); and more hiatal hernia (38% vs. 6%; P = 0.016).
  
  
  CONCLUSIONS
  This study suggests an inverse relation between glycemic control and GERD in morbidly obese patients. This can be partially explained by a lower frequency of hiatal hernia in patients with very poor glycemic control.
authors.affiliation: Programa de Pós-Graduação: Ciências em Gastroenterologia, Faculdade de Medicina, UFRGS, Porto Alegre-RS, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lauffer
authors.forename: Cassiano Mateus
authors.initials: CM
authors.lastname: Forcelini
authors.forename: Liana Ortiz
authors.initials: LO
authors.lastname: Ruas
authors.forename: Carlos Augusto Scussel
authors.initials: CA
authors.lastname: Madalosso
authors.forename: Fernando
authors.initials: F
authors.lastname: Fornari
mesh_terms: D000293:Adolescent; D000328:Adult; D001464:Barium; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D050782:Esophageal pH Monitoring; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001464:Barium; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human