GERD and Its Association with BMI in Adult Patients Undergoing Upper GI Endoscopy at the Kenyatta National Hospital

Abstract

Background: Gastroesophageal reflux disease (GERD) is a common clinical problem affecting millions of people worldwide. GERD is highly prevalent in morbidly obese patients and a high body mass index (BMI) is a risk factor for this condition. However, there is differing data on the use of BMI as a predictor of GERD, its severity and frequency. We therefore aimed to determine the association between GERD and high BMI and to document the esophageal mucosal changes in these patients during endoscopy. Methodology: We conducted a cross-sectional study among the 174 GERD patients to investigate the association between BMI and GERD at Kenyatta National Hospital endoscopy unit. Patients aged 18 years and above presenting with classical symptoms of GERD were evaluated upon voluntary enrolment. Ethical approval was sought from the KNH-UON ethics& research committee. A questionnaire was administered with demographic data (age, gender, weight, height) and specific questions assessing for GERD. At endoscopy, the mucosal changes were recorded. Data was then summarized using means, frequencies and proportions. Association between patient demographics and GERD was evaluated using the Student t-test or Mann–Whitney U test for continuous variables. Chi-square analysis was applied for categorical variables. A p-value of <0.05 was considered statistically significant. Results: This was an analysis of 174 patients (56.9% Female, 43.1% Male) between ages 18- 80 years (x̄=43) who underwent endoscopy. The BMI ranges were 14.5 to 38.6 Kg/m2 (x̄=26.6 Kg/m2). The proportion of patients who were overweight was 40.2% and obese patients made up 21.8% of the population. There was no significant association between BMI measurements and frequency scale of GERD (FSSG) symptoms (p=0.217). During endoscopy, 35.6% of the patients had esophagitis (LA-A -28.7%, LA-B – 6.9%). Hiatal hernia was diagnosed in 20.7% of the patients. There was no significant association between the diagnoses of esophagitis and hiatal hernia and the BMI status of the patients. However, older age was associated with a higher prevalence of hiatal hernia (p=0.002). Conclusion: There was no association between increasing BMI and frequency and severity of GERD symptoms in the study population.