Gastroenterology

Gastroenterology

Volume 130, Issue 3, March 2006, Pages 639-649
Gastroenterology

Clinical–alimentary tract
Obesity: A Challenge to Esophagogastric Junction Integrity

https://doi.org/10.1053/j.gastro.2005.12.016Get rights and content

Background & Aims: The aim of the current study was to analyze the relationship between obesity and the morphology of the esophagogastric junction (EGJ) pressure segment using high-resolution manometry. Methods: Two hundred eighty-five patients (108 men, aged 18–87) were studied. A solid-state manometric assembly with 36 circumferential sensors spaced 1 cm apart was placed transnasally, and simultaneous intra-esophageal and intragastric pressures were measured over 6–8 respiratory cycles. Separation of the lower esophageal sphincter (LES) and crural diaphragm was quantified by measuring the distance between the two EGJ elements during inspiration. The association between anthropometric variables and pressure values were examined using univariate and multivariate analysis. Results: There was a significant correlation of body mass index (BMI) and waist circumference (WC) with intragastric pressure (inspiration, BMI [r = 0.57], WC [r = 0.62] P < .0001; expiration, BMI [r = 0.58], WC [r = 0.64], P < .0001) and gastroesophageal pressure gradient (GEPG) (inspiration, BMI [r = 0.37], WC [r = 0.43], P < .0001; expiration, BMI [r = 0.24], WC [r = 0.26], P < .0001). Multivariate analysis adjusting for age, gender, and patient type did not alter the direction or magnitude of this relationship. In addition, obesity was associated with separation of the EGJ pressure components (BMI, r = 0.17, P < .005; WC, r = 0.21, P < .001). Conclusions: Obese subjects are more likely to have EGJ disruption (leading to hiatal hernia) and an augmented GEPG providing a perfect scenario for reflux to occur. Whether or not weight loss can reverse these abnormalities is unknown.

Section snippets

Patients

Three hundred fifty-five consecutive patients were studied prospectively using a standardized manometric protocol. Seventy subjects had previous gastric surgery, achalasia, or mechanical obstruction of the EGJ and were excluded. Manometric data from the remaining 285 patients (108 men, ages 18–87) were analyzed. Patients were enrolled from the gastrointestinal diagnostic laboratory at Northwestern Memorial Hospital without regard to presenting complaint. The subjects were classified into 3

Results

A total of 285 patients were studied. The mean age of the patients was 51.0 years (SD, 15.7) and their mean height and weight were 169.1 cm (SD, 10.0) and 77.9 kg (SD, 22.0), respectively. Mean BMI and WC of the patients was 27.2 kg/m2 (SD, 7.8) and 94.5 cm (SD, 16.6). Approximately two-thirds were women (62%). There were no significant differences in BMI between men and women, but men had a higher WC than women (98.9 versus 90.9 cm). Using visual analog scale data from the symptom assessment

Discussion

The major findings of this study were that the pressure morphology within and across the EGJ is altered with obesity in a fashion that would augment the flow of gastric juice into the esophagus. Particularly during the inspiratory phase of respiration, increased intragastric pressure and GEPG were strongly correlated with increased BMI. Both factors correlated even more strongly with WC suggesting this to be the mediator in the causal pathway of the BMI effect. There was a dose–response

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  • Cited by (0)

    Supported by RO1 DC00646 (PJK) and K23 DK062170-01 (JEP) from the Public Health Service.

    Contributed devices from Sierra Scienti .c,Inc.

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