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Management
Obesity and Gastrointestinal Disorders
MASLD
➤ In adults with overweight or obesity and MASLD, recommend at
least 5% weight loss to decrease liver fat, 7% to 10% weight loss
to reduce liver inflammation, and greater than 10% weight loss to
treat fibrosis.
➤ Avoid sugar-sweetened beverages, reduce intake of
ultraprocessed foods, limit saturated fat, and increase intake of
high-fiber foods and fish.
➤ Recommend >150 minutes of moderate-intensity or >75 minutes
of vigorous-intensity physical activity per week.
➤ In adults with MASH and stage 2 or higher liver fibrosis, consider
referral to hepatology.
➤ In adults with MASH and stage 2 to 3 liver fibrosis, consider US
Food and Drug Administration (FDA)-approved treatment with
semaglutide or resmetirom.
GERD
➤ Weight loss can improve symptoms of GERD in individuals with
obesity and overweight.
➤ Avoid meals within two or three hours of bedtime.
➤ Identify and avoid foods that can trigger GERD symptoms.
➤ For individuals with erosive esophagitis, treat with proton pump
inhibitors (PPIs) rather than histamine-2-receptor antagonists.
➤ In individuals with GERD whose symptoms resolve with PPI
therapy and who do not have erosive esophagitis or Barrett
esophagus, recommend a trial of discontinuing
➤ PPIs and using them only when symptoms recur.
➤ In individuals with GERD who need maintenance therapy with
PPIs, recommend treatment with the lowest effective dose
required to control symptoms and heal reflux esophagitis.
➤ In individuals with more severe erosive esophagitis (grade C or D),
recommend long-term therapy with PPIs.
➤ In individuals with GERD undergoing metabolic and bariatric
surgery, recommend Roux-en-Y gastric bypass over sleeve
gastrectomy.
