Relationship between BMI and upper gastrointestinal pathologies

Obesity is a recognized risk factor for gastrointestinal diseases and is also suspected of aggravating intestinal reflux, causing intestinal atrophy and metaplasia, and an increased risk of carcinogenesis. This study aimed to evaluate the prevalence of upper gastrointestinal pathologies in patients undergoing esophagogastroduodenoscopy procedures, including their relationship to patient body mass index (BMI) values. This retrospective analysis included 368 consecutive outpatients examined by a single physician from March 1, 2023 to February 29, 2024. The analysis was based on the results of endoscopic and histopathological examinations in the patient group. We collected their baseline characteristics. The assessment of endoscopy results included the Campylobacter-like organism screening, status of erosive esophagitis, degree of endoscopic signs of gastroesophageal reflux disease as assessed during endoscope withdrawal, status of Z-line displacement as per the Prague classification, degree of Z-line displacement relative to the diaphragmatic branches, and nature of the gastric lake contents. Histopathological assessment focused on the presence of chronic inflammation and the features of active inflammatory processes, foveolar hyperplasia, gastric mucosal atrophy, intestinal metaplasia, and Barrett esophagus. A correlation was observed between the BMI and the prevalence of esophageal hiatal hernia, particularly in relation to large hernias. Interestingly, an inverse relationship was shown regarding the incidence of intestinal reflux. Although biliary reflux and Helicobacter pylori infection increased the incidence of intestinal metaplasia in gastric mucosa and Barrett esophagus, these findings were not statistically significant. Furthermore, concomitant thyroid diseases were associated with a higher incidence of biliary reflux and Barrett esophagus. Although BMI correlated with a higher prevalence of large esophageal hiatal hernias, an inverse association was observed with intestinal reflux. Additionally, thyroid diseases were linked to higher incidences of biliary reflux and Barrett esophagus.