الفهرس 
Gastroesophageal reflux disease GERD)Only 14 pages are availabe for public view
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Abstract
Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder. It is defined as a “condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications.
Obesity is a significant problem which increases acid reflux and thus increases GERD and its complications. Several studies have demonstrated overweight and obesity are strong independent risk factor of GERD symptoms and esophageal erosions.
There is an increasing recognition that central obesity, rather than overall BMI is a particularly strong risk factor for GERD and its complications.
Human leptin is a protein of 167 amino acids. It is manufactured primarily in the adipocytes of white adipose tissue and the level of circulating leptin is directly proportional to the total amount of fat in the body. In addition to white adipose tissue (the major source of leptin) it can also be produced by brown adipose tissue, placenta (syncytiotrophoblast), ovaries, skeletal muscle, mammary epithelial cells, bone marrow, pituitary and
liver.
We conducted this study to evaluate:-
1) The impact of different anthropometric measures on clinical and endoscopic severity of GERD in Egyptian patients.
2) The relation between serum leptin and clinical and endoscopic severity of GERD in Egyptian patients.
This study was conducted on 60 patients with symptoms suggestive of GERD. they were classified According to the proposed classification of obesity which depends on two anthropometric indices that are surrogate markers of general (BMI) and abdominal obesity (WHtR) into two groups.
Group 1: 30 patients with overweight and obesity(BMI
≥ 25 OR WHtR ≥ 0.5 ).
Group 2: 30 patients with normal weight (BMI ≥ 18 to
< 25 OR WHtR ≥0.4 to <0.5).
Control group: 20 healthy subjects, matched for age and gender, were included for assessment of serum leptin hormone. All included controls had average weight (BMI
≥ 18 to < 25 OR WHtR ≥0.4 to <0.5).
All studied patients were subjected to :
Full history taking with special stress on GERD symptoms where especial questionnaire was designed to determine the severity and duration of symptoms of GERD, clinical examination, anthropometric measurements, upper GIT endoscopy , Laboratory investigations (CBC, KFT and LFT), and serum leptin hormone measurement.
Biopsies were taken from the lower esophagus in 17 patients for histopathological examination and the findings are classified as.
• BE (columnar intestinal metaplasia) and dysplasia (HGD) (5 patients in group 1 1 patients in group 2)
• Esophagitis (7 patients in group 1 a n d 4 patients in group 2).
Our results showed:-
1. The symptom score severity ,severity of GERD grade by endoscopic findings and serum leptin hormone were higher in patients of group 1 (over weight & obese ) in relation to patients of group 2 (normal weight).
2. There was significant relation between age & GERD grade, also there was statistical significant difference between
GERD patients & patients with complications regarding age, we found that age was higher in patients with complications (ulcer & BE).
3. There was significant statistical difference between symptom score severity regarding endoscopic findings, patients with GERD grade C&D had higher symptom score than patients with GERD grade A&B.
4. There was significant statistical difference between the symptom score severity regarding weight, BMI, WC, HC and WHt ratio, obesity parameters were higher in patients with higher symptom score.
5. There was significant statistical difference between GERD G A&B patients and GERD grade C&D patients regarding weight, BMI, WC, HC, WHt ratio and WHp ratio, being higher in patients with GERD grade C&D.
6. There was significant statistical difference between the different symptom score severity regarding TAF, IAAT and SCAT, abdominal fat depots were higher in patients with higher symptom score.
7. There was significant statistical difference between GERD G A&B patients and GERD grade C&D patients regarding TAF, IAAT and SCAT, abdominal fat
depots were higher in patients with GERD grade C&D.
8. There was significant statistical difference between the different symptom score severity regarding leptin hormone, leptin hormone was higher in patients with higher symptom score.
9. There was significant statistical difference between the different symptom score severity regarding leptin hormone, leptin hormone was higher in patients with GERD G C&D.
10.There was significant positive correlation between leptin hormone and symptom score severity, weight, BMI, WC, HC, WHt ratio, TAF, SCAT and IAAT and significant negative correlation with WHp ratio in patients with GERD.
11.There was significant positive correlation between leptin hormone and weight, height, BMI, WC, HC, WHt ratio, TAF, SCAT and IAAT and significant negative correlation with WHp ratio in patients with complications.
12.Prediction model of GERD shows that weight, BMI, WC, HC, TAF and SCAT were significant predictor for GERD.
13.Multivariate for GERD grade (C&D) using the following factors TAF, weight, BMI>25, leptin and SCAT, it was found that TAF, weight, BMI>25 and leptin remained significantly associated with GERD grade (C&D).