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Obesity: Barrett’s Esophagus and Esophageal Cancer Risk

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Revisiting Barrett's Esophagus

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Abstract

The association between obesity and gastro-esophageal reflux disease (GERD) has been demonstrated. The factors leading to GERD are mechanical or related to changes in esophageal motility. Morbid obesity seems to be related with GERD. It has an effect on esophago-gastric junction by increasing intra-abdominal pressure, even without creating a hiatal hernia. The main complication of GERD is the occurrence of a Barrett’s esophagus (BE). The odds-ratio of BE increases with the body mass index (BMI). The main complication of BE is its conversion into adenocarcinoma. The recent increase of the incidence of the adenocarcinoma of the cardia and an increased risk of lower esophageal adenocarcinoma has been therefore related to the increase of obesity. Bariatric surgery is an effective and long lasting approach to weight loss, and the data have generally shown that this weight loss can have positive effects on GERD. Restrictive bariatric procedures as laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG), although effective in obtaining weight loss, due to the consistent data regarding postsurgical development and worsening of GERD, are generally not recommended in patients with pre-existing reflux. Conversely, Roux-en-Y gastric bypass (RYGB) is currently recommended for morbidly obese patients with GERD or Barrett’s esophagus given the superior reflux control of both acid and non-acid events compared to other bariatric surgeries. Although showing promising results, further studies remain necessary to define the positive effects of Mini/One Anastomosis Gastric Bypass (MGB/OAGB) on GERD control.

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Authors and Affiliations

  1. Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Paris, France

    Jean Marc Chevallier

  2. Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

    Sonja Chiappetta

  3. General Surgery Unit, Department of Advanced Biomedical Sciences, University Federico II—School of Medicine, Naples, Italy

    Mario Musella

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  1. Jean Marc Chevallier
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  2. Sonja Chiappetta
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  3. Mario Musella
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Correspondence to Jean Marc Chevallier .

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  1. Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy

    Giuseppe Galloro

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Chevallier, J.M., Chiappetta, S., Musella, M. (2019). Obesity: Barrett’s Esophagus and Esophageal Cancer Risk. In: Galloro, G. (eds) Revisiting Barrett's Esophagus. Springer, Cham. https://doi.org/10.1007/978-3-319-92093-1_5

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  • DOI: https://doi.org/10.1007/978-3-319-92093-1_5

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