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Gastroesophageal reflux disease (GERD) patients who were overweight were able to limit the need for acid-blocking medications and shed pounds when they enrolled in a multidisciplinary weight management program, a researcher reported.

In 66 patients with GERD enrolled in a weight management clinic, use of acid blockers was reduced at 18 months follow-up, with 30% of the cohort ceasing all acid-blocking medications and another 15% reducing their dosage while on the intervention, according to Aiya Aboubakr, MD, of New York Presbyterian-Weill Cornell Medical Center in New York City.

Among the cohort, 77.3% reduced their weight by a median 2.88 kg (6.35 lb, P<0.001), while one-third dropped more than 5% of their total body weight and over two-thirds saw a median reduction in BMI (median 0.97 kg; P<0.001), she said at the American College of Gastroenterology (ACG) virtual meeting.

Interestingly, medication de-escalation was not associated with absolute changes in weight or BMI. "Further study is needed to assess the effects of absolute weight loss and body composition in patients with confirmed acid-mediated reflux disease," Aboubakr said.

"I find the results convincing and important and fit well with a clinical impression that many have had for a long time, as well as evidence of a relationship between obesity and GERD," said Eamonn Quigley, MD, of Houston Methodist Hospital and ACG past president. "However, good studies of the real impact of BMI and other lifestyle factors in GERD are few and far between, so this study is very welcome."

GERD affects about one-quarter of Americans. While proton-pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) are a mainstay of treatment, they are often inappropriately used long-term, according to Aboubakr. Prior research has shown an association between increasing BMI and more frequent reflux symptoms, which can lead to increased dosages of these acid-suppressing medications.

"This study was important to demonstrate the significant role lifestyle interventions play in the de-escalation of acid-suppressing therapy," said Anish Patel, DO, of the Brooke Army Medical Center in Fort Sam Houston in Texas, who was not involved in this study. "In our clinical practice, we strongly encourage such lifestyle interventions to optimize current management and mitigate unnecessary escalation in therapy."

For their study, the researchers evaluated 66 patients (mean age 52) with documented GERD and a BMI greater than 25 enrolled from April 2019 to November 2020 in a weight management clinic -- the Innovative Center for Nutrition and Gastroenterology (I-CHANGE).

Patients received dietary and weight loss counseling by a gastroenterologist or hepatologist, a dietitian, and were seen by an endocrinologist or cardiologist if necessary. Participants needed to have at least one follow-up visit at the time of chart review, and bariatric surgery patients were excluded.

The primary outcome assessed de-escalation of acid-suppressing therapy. Weight loss and body composition changes were secondary outcomes.

Data collected included weight, percentage of body fat, BMI, acid-suppressing therapy use, as well as measurements of truncal adiposity. The lifestyle modification program encouraged personalized meal planning, the Mediterranean diet, healthy sleep habits, smoking cessation, and up to 200 minutes of exercise each week.

Among the cohort, 70% were on acid-suppressing treatment, including PPIs in 58%, H2RAs in 17%, both in 11%, and antacids in 6%. Two-thirds of the patients were women, and comorbidities included non-alcoholic fatty liver disease in 62%, hyperlipidemia in 53%, and hypertension in 41%. Average BMI was 33.6, truncal body fat was 397%, and mean weight was 96 kg (211 lb).

Among the 30 patients with body composition markers available, 73% experienced significant reductions in body fat and truncal fat.

The analysis had several limitations, the researchers acknowledged, including that the weight loss program may be costly for both providers and patients, which could limit its use. The study also had a small sample size and patient follow-up was lacking due to the COVID-19 pandemic.

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