title: Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?
abstract: OBJECTIVE
  To evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure.
  
  
  METHODS
  We conducted a cross-sectional study of 58 patients: 30 MO (cases) and 28 non-MO (controls). Esophageal symptoms and esophageal sensitivity to 0.1 M hydrochloric acid solution (Bernstein test) were compared between MO and non-MO patients with a prior diagnosis of abnormal esophageal acid exposure.
  
  
  RESULTS
  MO patients were less symptomatic than non-MO controls (14% vs 96%; odds ratio [OR], 0.006; 95% confidence interval [CI], 0.001 to 0.075; p=0.000). MO patients were more likely to present with decreased esophageal sensitivity to the instillation of acid than non-MO controls (57% vs 14%; OR, 8; 95% CI, 1.79 to 35.74; p=0.009). Subgroup analysis revealed no differences in esophageal sensitivity in MO patients with and without abnormal esophageal acid exposure (43% vs 31%; p=0.707).
  
  
  CONCLUSIONS
  Silent gastroesophageal reflux disease (GERD) is common among MO individuals, likely due to decreased esophageal sensitivity to acid. The absence of typical GERD symptoms in these patients may delay discovery of precancerous conditions, such as Barrett's esophagus. We believe that these patients may require a more aggressive diagnostic work-up to rule out the presence of silent GERD.
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ortiz
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Alvarez-Sotomayor
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Sáez-González
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Francia Carolina
authors.initials: FC
authors.lastname: Díaz-Jaime
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Iborra
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Ponce
authors.affiliation: Digestive Functional Disorders Unit, Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.|Department of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Garrigues
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods*
keywords: Acid reflux; Gastroesophageal reflux; Obesity; Sensitivity; pH monitoring