title: [Specific features of gastroesophageal reflux disease associated with obesity and overweight].
abstract: OBJECTIVE
  To reveal the specific features of gastroesophageal reflux disease (GERD) associated with obesity and overweight, by investigating the clinical and endoscopic manifestations of the disease, 24-hour pH-metry scores, and leptin levels.
  
  
  METHODS
  A total of 131 patients with GERD were examined. The data about complaints and those from life and medical histories were collected; anthropometric measurements and the results of blood biochemical tests, esophagoduodenoscopy (EPDS), and pH-metry were assessed; and the serum levels of leptin and its receptor were estimated. The patients were allocated into a study group (104 obese and/or overweight patients) and a comparison one (27 normal weight people).
  
  
  RESULTS
  Waist circumference, hip circumference, and blood glucose levels proved to be statistically significantly higher in the study group (p<0.00000, p<0.00002, and p<0.02, respectively). The obese patients were found to have a statistically significantly higher level of leptin and a lower level of its soluble receptors: the median leptin levels were 30.42 (13.42-45.62) ng/ml in the study group and 5.47 (3.35-7.68) ng/ml in the comparison group; the median levels of the receptors were 18.83 (14.98-25.11) ng/ml and 30.93 (24.68-33.53) ng/ml, respectively). This group showed a moderate negative correlation between these indicators (rs=-0.451; p<0.0004). The study group displayed higher pH values in the gastric cardia and body (p<0.05 and p<0.04, respectively). The mucosal contact time with the refluxate having with a low pH value (<4) in the above segments turned out to be longer in the comparison group (p<0.05). There were weight-independent relationships of the leptin level to its spread, aggressiveness quotient, to the highest pH value in the gastric cardia and body, and to the mucosal contact time with the refluxate having a pH below 4.0 (rs=0.543; p<0.006; rs=0.432; p<0.04; rs=0.431; p<0.04; rs=-0.450; p<0.03, respectively), leptin receptors with a pH ratio in the gastric cardia and body, to the number of reflux episodes longer than 5 minutes in the esophagus, and to the De Meester index for this indicator (rs=0.471; p<0.04; rs=-0.455; p<0.04; rs=-0,454; p<0.04, respectively).
  
  
  CONCLUSIONS
  Obese and overweight patients develop GERD in the presence of leptin resistance and biliary tract disease, which determines the specific features of the disease (alkaline or mixed refluxate) and the need for individualized therapy.
authors.affiliation: Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia.
authors.forename: M A
authors.initials: MA
authors.lastname: Livzan
authors.affiliation: Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia.
authors.forename: I V
authors.initials: IV
authors.lastname: Lapteva
authors.affiliation: Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia.
authors.forename: T S
authors.initials: TS
authors.lastname: Krolevets
authors.affiliation: Omsk Regional Clinical Medical Sanitary Unit Nine, Omsk, Russia.
authors.forename: I E
authors.initials: IE
authors.lastname: Kiselev
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000453:epidemiology*; D015992:Body Mass Index; D001835:Body Weight; D015897:Comorbidity; D016145:Endoscopy, Digestive System / Q000379:methods; D050782:Esophageal pH Monitoring / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D054411:Receptors, Leptin / Q000097:blood*; D012307:Risk Factors; D012426:Russia; D013223:Statistics as Topic
chemical_list: D020738:Leptin; D054411:Receptors, Leptin