PMID- 28267445
DCOM- 20170814
LR  - 20180405
IS  - 1528-0012 (Electronic)
IS  - 0016-5085 (Linking)
VI  - 152
IP  - 8
DP  - 2017 Jun
TI  - Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily
      by Impairing Esophageal Clearance.
PG  - 1881-1888
LID - S0016-5085(17)30231-7 [pii]
LID - 10.1053/j.gastro.2017.02.036 [doi]
AB  - BACKGROUND & AIMS: Central obesity promotes gastroesophageal reflux, which may be
      related to increased intra-abdominal pressure. We investigated the effect of
      increasing abdominal pressure by waist belt on reflux in patients with reflux
      disease. METHODS: We performed a prospective study of patients with esophagitis
      (n = 8) or Barrett's esophagus (n = 6); median age was 56 years and median body
      mass index was 26.8. Proton pump inhibitors were stopped at least 7 days before
      the study and H2 receptor antagonists were stopped for at least 24 hours before. 
      The severity of upper GI symptoms was assessed and measurements of height,
      weight, and waist and hip circumference taken. Combined high-resolution pH
      measurement and manometry were performed in fasted state for 20 minutes and for
      90 minutes following a standardized meal. The squamocolumnar junction was marked 
      by endoscopically placed radiopaque clips. The procedures were performed with and
      without a waist belt (a weight-lifter belt applied tightly and inflated to a
      constant cuff pressure of 50 mmHg). We compared variables between groups using
      the Wilcoxon Signed Rank test and tested for correlations using Spearman Rho
      bivariate analysis. RESULTS: Without the belt, intragastric pressure correlated
      with waist circumference (r = 0.682; P = .008), with the range in pressure
      between smallest and largest waist circumference being 15 mmHg. The belt
      increased intragastric pressure by a median of 6.9 mmHg during fasting (P = .002)
      and by 9.0 mmHg after the meal (P = .001). Gastroesophageal acid reflux at each
      of the pH sensors extending 5.5 cm proximal to the peak lower esophageal
      sphincter pressure point was increased by approximately 8-fold by the belt (all P
      < .05). Following the meal, the mean number of reflux events with the belt was 4,
      vs 2 without (P = .008). Transient lower esophageal sphincter relaxations were
      not increased by the belt, but those associated with reflux were increased (2 vs 
      3.5; P = .04). The most marked effect of the belt was impaired esophageal
      clearance of refluxed acid (median values of 23.0 seconds without belt vs 81.1
      seconds with belt) (P = .008). The pattern of impaired clearance was that of
      rapid re-reflux after peristaltic clearance. CONCLUSIONS: In a prospective study 
      of patients with esophagitis or Barrett's esophagus, we found belt compression
      increased acid reflux following a meal. The intragastric pressure rise inducing
      this effect is well within the range associated with differing waist
      circumference and likely to be relevant to the association between obesity and
      reflux disease.
CI  - Copyright (c) 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Mitchell, David R
AU  - Mitchell DR
AD  - Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences,
      University of Glasgow, Glasgow, UK.
FAU - Derakhshan, Mohammad H
AU  - Derakhshan MH
AD  - Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences,
      University of Glasgow, Glasgow, UK.
FAU - Wirz, Angela A
AU  - Wirz AA
AD  - Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences,
      University of Glasgow, Glasgow, UK.
FAU - Ballantyne, Stuart A
AU  - Ballantyne SA
AD  - Department of Clinical Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK.
FAU - McColl, Kenneth E L
AU  - McColl KEL
AD  - Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences,
      University of Glasgow, Glasgow, UK. Electronic address:
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170303
PL  - United States
TA  - Gastroenterology
JT  - Gastroenterology
JID - 0374630
SB  - IM
MH  - Adult
MH  - Aged
MH  - Barrett Esophagus/diagnosis/*etiology/physiopathology
MH  - Body Mass Index
MH  - Clothing/*adverse effects
MH  - Constriction
MH  - Endoscopy, Gastrointestinal
MH  - Esophageal pH Monitoring
MH  - Esophagitis/diagnosis/*etiology/physiopathology
MH  - Esophagus/*physiopathology
MH  - Female
MH  - Gastroesophageal Reflux/diagnosis/*etiology/physiopathology
MH  - Humans
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - Obesity, Abdominal/*complications/diagnosis
MH  - Predictive Value of Tests
MH  - Pressure
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Waist Circumference
MH  - Young Adult
OT  - *Barrett's Esophagus
OT  - *Central Obesity
OT  - *Lower Esophageal Sphincter
OT  - *Transient Lower Esophageal Sphincter Relaxations
EDAT- 2017/03/08 06:00
MHDA- 2017/08/15 06:00
CRDT- 2017/03/08 06:00
PHST- 2016/11/07 00:00 [received]
PHST- 2017/02/23 00:00 [revised]
PHST- 2017/02/24 00:00 [accepted]
PHST- 2017/03/08 06:00 [pubmed]
PHST- 2017/08/15 06:00 [medline]
PHST- 2017/03/08 06:00 [entrez]
AID - S0016-5085(17)30231-7 [pii]
AID - 10.1053/j.gastro.2017.02.036 [doi]
PST - ppublish
SO  - Gastroenterology. 2017 Jun;152(8):1881-1888. doi: 10.1053/j.gastro.2017.02.036.
      Epub 2017 Mar 3.