Clinical–alimentary tractObesity: A Challenge to Esophagogastric Junction Integrity
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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Supported by RO1 DC00646 (PJK) and K23 DK062170-01 (JEP) from the Public Health Service.
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