Symptoms and quality of life in underweight gastroesophageal reflux disease patients and therapeutic responses to proton pump inhibitors

Background and Aim: A correlation to obesity has been reported in patients with gastroesophageal reflux disease (GERD). However, insufficient data have been obtained regarding underweight GERD patients. Post hoc analysis of a multicenter prospective cohort study was conducted to evaluate subjective symptoms and health‐related quality of life (HRQOL) in underweight GERD patients (body mass index [BMI] < 18.5) and to evaluate therapeutic response to proton pump inhibitors. Methods: A total of 2646 patients who underwent endoscopy were classified by BMI and analyzed. Rabeprazole was administered for 8 weeks. Subjective symptoms and HRQOL were assessed using questionnaires (F‐Scale and SF‐8?). Results: Baseline endoscopy revealed 29.2% of patients had non‐erosive reflux disease (NERD). Underweight status was identified in 5.8% of GERD patients, and mean baseline symptoms score and SF‐8 physical component summary (PCS) score were 18.6 and 42.4, respectively, reflecting greater impairment compared with the values of 15.4 and 45.6 in normal‐weight patients (BMI ≥ 22 but < 25). Treatment with rabeprazole resulted in a decrease from 18.6 at baseline to 6.7 at week 8 in underweight reflux esophagitis subjects, and from 15.0 to 6.3 in underweight NERD patients. PCS score improved in underweight patients. These changes were about the same as in normal‐weight or obese patients. Conclusions: Japanese GERD patients are often obese, as reported previously, but some GERD patients are underweight. Baseline symptoms and QOL in underweight GERD patients tended to be more severe than in normal‐weight patients, but therapeutic response with proton pump inhibitors was about the same as in normal‐weight or obese patients.