Lifestyle modification in patients with non-erosive reflux disease and overweight or obesity
S.V. Tikhonov, V.I. Simanenkov, N.V. Bakulina, N.B. Lischuk
North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia
Background. Obesity and gastroesophageal reflux disease are comorbid pathologies. A significant proportion of patients with non- erosive gastroesophageal reflux disease (NERD) have failed standard acid-suppressive therapy. The effectiveness of weight loss inter¬ventions and the effectiveness of acid suppression therapy has not been compared in patients with NERD and obesity.
Objective. Comparison of the effectiveness of lifestyle changes (diet therapy, intensification of physical activity) and traditional therapy with proton pump inhibitors (PPIs) in overweight or obese patients with non-erosive reflux disease (NERD).
Methods. The randomized clinical trial involved 30 patients with NERD, 12 (40%) men and 18 (60%) women of middle age, median age 51.5 (45; 62) years. 17(56.66%) patients were overweight, 13 (43.33%) - obese, and 27(90%) - with abdominal obesity. Patients were randomized into two groups: control group - 15 patients who received initial therapy with omeprazole 20 mg 1 time per day for 4 week, then maintenance therapy with omeprazole 10 mg 1 time per day for 5 months; intervention group - 15 patients who participated in the program for the correction of eating behavior for 6 months and received only initial therapy with omeprazole 10 mg 1 time per day for 4 weeks. The follow-up duration was 6 months. The effectiveness of the two treatments was compared by assessing the symptoms of gastroesophageal reflux disease, 24-hour pH-impedancemetry, levels of anxiety, depression, and quality of life.
Results. At 1, 3, and 6 months, standard and experimental treatments had similar effects on heartburn and regurgitation symptoms. At the same time, by the sixth month of treatment, in the group of correction of eating behavior, personal anxiety was significantly lower, the quality of life according to the vitality scale of and the role-emotional scale was higher; 24-hour pH-impedancemetry revealed a lower total number of gastroesophageal refluxes (GERs), acid GERs, proximal acid GERs, less % of the time with pH <4.
Conclusion. The study demonstrated the benefit of lifestyle modification over traditional PPI therapy in overweight or obese patients with NERD. Eating behavior modification and weight loss are similar to PPI therapy in terms of influencing the main symptoms of gastro-esophageal reflux disease (heartburn and regurgitation), while improving upper gastrointestinal motility, reducing the number of distal and proximal acid GERs.
About the Autors
Corresponding author: Sergey V. Tikhonov, Cand. Sci. (Med.), Associate Professor at the Department of Internal Medicine, Clinical Pharmacology and Nephrology, North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia; email@example.com