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Effect of Obesity on Foregut Physiology

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The SAGES Manual of Physiologic Evaluation of Foregut Diseases

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Abstract

Obesity in the United States and internationally is on the rise. Obesity can significantly alter the anatomy and physiology of patients and can induce specific alterations to the foregut. Changes to the esophagus include esophageal body dysmotility, lower esophageal sphincter dysfunction, and crural diaphragmatic weakening causing hiatal hernia. Also, obese patients experience gastric hormonal and endocrine abnormalities, as well as variations in stomach size and motility. All of these anatomic and physiologic derangements can contribute to the development of specific pathophysiologic states including gastroesophageal reflux disease, Barrett’s esophagus, and, in some cases, esophageal adenocarcinoma. While the advent of bariatric surgery may allow the halting of these pathologic processes, or in some cases even reversal, certain foregut abnormalities have been linked to post-bariatric surgery patients as well. This illustrates the need for clinicians taking care of bariatric patients to not only be aware of these functional derangements, but plan treatments and interventions accordingly.

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Further Reading

  • Kristo I, et al. Modern esophageal function testing and gastroesophageal reflux disease in morbidly obese patients. Obes Surg. 2019;29(11):3536–41.

    Article  PubMed  Google Scholar 

  • Nam SY. Obesity-related digestive diseases and their pathophysiology. Gut Liver. 2017;11(3):323–34.

    Article  CAS  PubMed  Google Scholar 

  • Tack J, Pandolfino JE. Pathophysiology of gastroesophageal reflux disease. Gastroenterology. 2018;154(2):277–88.

    Article  CAS  PubMed  Google Scholar 

  • Valezi AC, et al. Gastroesophageal reflux disease in obese patients. J Laparoendosc Adv Surg Tech A. 2018;28(8):949–52.

    Article  PubMed  Google Scholar 

  • Xing J, Chen JD. Alterations of gastrointestinal motility in obesity. Obes Res. 2004;12(11):1723–32.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Ryan Lamm & Francesco Palazzo

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  1. Ryan Lamm
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  2. Francesco Palazzo
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Correspondence to Francesco Palazzo .

Editor information

Editors and Affiliations

  1. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Ankit D. Patel

  2. BMI Surgical Institute, Atlanta, GA, USA

    Amir Aryaie

  3. Department of Surgery, University of Alabama at Birmingham and Birmingham VA Health Care System, Birmingham, AL, USA

    Jayleen Grams

  4. Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA

    Leena Khaitan

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© 2023 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Lamm, R., Palazzo, F. (2023). Effect of Obesity on Foregut Physiology. In: Patel, A.D., Aryaie, A., Grams, J., Khaitan, L. (eds) The SAGES Manual of Physiologic Evaluation of Foregut Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-39199-6_3

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  • DOI: https://doi.org/10.1007/978-3-031-39199-6_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-39198-9

  • Online ISBN: 978-3-031-39199-6

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