Weight Loss Is Truly Effective in Reducing Symptoms and Proton Pump Inhibitor Use in Patients With Gastroesophageal Reflux Disease

We read with interest the study by Ness-Jensen et al,1 which was a narrative review providing appraisal of data from meta-analyses, systematic reviews, randomized clinical trials, and prospective observational studies (from 1946 to October 2014) on the role of lifestyle interventions in gastroesophageal reflux disease (GERD). The authors concluded that weight loss and tobacco smoking cessation should be recommended to GERD patients who are obese and smoke, respectively. Moreover, they stated that avoiding late evening meals and head of the bed elevation is effective in nocturnal GERD. We congratulate the authors because data on this topic are limited and unclear, and an explanatory review was absolutely necessary. In particular, the relevance of weight loss in overweight/obese patients with reflux symptoms is controversial, although the role of body mass index as a risk factor for GERD has been highlighted in several articles and reviews.2–4 In keeping, we wonder that not all the available studies in literature have been quoted since we recently published data from a comparative, prospective, nonrandomized study analyzing the efficacy of a hypocaloric diet and physical exercise vs a standard-of-care dietetic program without any change in daily caloric intake, in patients with reflux symptoms and an endoscopically proven erosive esophagitis.5 We showed that weight loss, obtained through a tailored dietetic program and increased aerobic exercise (101 patients enrolled), was as follows: (1) associated with a reduction in body mass index, and waist and hip circumference; (2) associated with a higher reduction of GERD-related typical symptoms; and (3) able to obtain a reduction/discontinuation of proton pump inhibitor dosage.5 Showing that reducing weight loss leads patients with GERD to reduce medication intake, we speculated that this kind of intervention may further reduce the National Health System costs as a direct consequence.5 In summary, our data confirm that lifestyle interventions and in particular a 10% weight loss is truly effective in reducing symptoms and PPI use in patients with GERD. This suggestion also has been corroborated by the recent European guideline for management of obesity and overweight in adults.6 However, it is important to bear in mind that weight loss management has to be associated with a cognitive-behavior therapeutic approach with a tight scheduled follow-up evaluation to obtain a high percentage of adherence to a weight loss protocol