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Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure.
Am J Gastroenterol 2008; 103(6):1349-54AJ

Abstract

OBJECTIVES

The roles of intragastric pressure (IGP), intraesophageal pressure (IEP), gastroesophageal pressure gradient (GEPG), and body mass index (BMI) in the pathophysiology of gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are only partly understood.

METHODS

In total, 149 GERD patients underwent stationary esophageal manometry, 24-h pH-metry, and endoscopy.

RESULTS

One hundred three patients had HH. Linear regression analysis showed that each kilogram per square meter of BMI caused a 0.047-kPa increase in inspiratory IGP (95% confidence interval [CI] 0.026-0.067) and a 0.031-kPa increase in inspiratory GEPG (95% CI 0.007-0.055). Each kilogram per square meter of BMI caused expiratory IGP to increase with 0.043 kPa (95% CI 0.025-0.060) and expiratory IEP with 0.052 kPa (95% CI 0.027-0.077). Each added year of age caused inspiratory IEP to decrease by 0.008 kPa (95% CI -0.015-0.001) and inspiratory GEPG to increase by 0.008 kPa (95% CI 0.000-0.015). In binary logistic regression analysis, HH was predicted by inspiratory and expiratory IGP (odds ratio [OR] 2.93 and 2.62, respectively), inspiratory and expiratory GEPG (OR 3.19 and 2.68, respectively), and BMI (OR 1.72/5 kg/m(2)). In linear regression analysis, HH caused an average 5.09% increase in supine acid exposure (95% CI 0.96-9.22) and an average 3.46% increase in total acid exposure (95% CI 0.82-6.09). Each added year of age caused an average 0.10% increase in upright acid exposure and a 0.09% increase in total acid exposure (95% CI 0.00-0.20 and 0.00-0.18).

CONCLUSIONS

BMI predicts IGP, inspiratory GEPG, and expiratory IEP. Age predicts inspiratory IEP and GEPG. Presence of HH is predicted by IGP, GEPG, and BMI. GEPG is not associated with acid exposure.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18510603

Citation

de Vries, Durk R., et al. "Gastroesophageal Pressure Gradients in Gastroesophageal Reflux Disease: Relations With Hiatal Hernia, Body Mass Index, and Esophageal Acid Exposure." The American Journal of Gastroenterology, vol. 103, no. 6, 2008, pp. 1349-54.
de Vries DR, van Herwaarden MA, Smout AJ, et al. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure. Am J Gastroenterol. 2008;103(6):1349-54.
de Vries, D. R., van Herwaarden, M. A., Smout, A. J., & Samsom, M. (2008). Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure. The American Journal of Gastroenterology, 103(6), pp. 1349-54. doi:10.1111/j.1572-0241.2008.01909.x.
de Vries DR, et al. Gastroesophageal Pressure Gradients in Gastroesophageal Reflux Disease: Relations With Hiatal Hernia, Body Mass Index, and Esophageal Acid Exposure. Am J Gastroenterol. 2008;103(6):1349-54. PubMed PMID: 18510603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure. AU - de Vries,Durk R, AU - van Herwaarden,Margot A, AU - Smout,André J P M, AU - Samsom,Melvin, Y1 - 2008/05/28/ PY - 2008/5/31/pubmed PY - 2008/7/30/medline PY - 2008/5/31/entrez SP - 1349 EP - 54 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 103 IS - 6 N2 - OBJECTIVES: The roles of intragastric pressure (IGP), intraesophageal pressure (IEP), gastroesophageal pressure gradient (GEPG), and body mass index (BMI) in the pathophysiology of gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are only partly understood. METHODS: In total, 149 GERD patients underwent stationary esophageal manometry, 24-h pH-metry, and endoscopy. RESULTS: One hundred three patients had HH. Linear regression analysis showed that each kilogram per square meter of BMI caused a 0.047-kPa increase in inspiratory IGP (95% confidence interval [CI] 0.026-0.067) and a 0.031-kPa increase in inspiratory GEPG (95% CI 0.007-0.055). Each kilogram per square meter of BMI caused expiratory IGP to increase with 0.043 kPa (95% CI 0.025-0.060) and expiratory IEP with 0.052 kPa (95% CI 0.027-0.077). Each added year of age caused inspiratory IEP to decrease by 0.008 kPa (95% CI -0.015-0.001) and inspiratory GEPG to increase by 0.008 kPa (95% CI 0.000-0.015). In binary logistic regression analysis, HH was predicted by inspiratory and expiratory IGP (odds ratio [OR] 2.93 and 2.62, respectively), inspiratory and expiratory GEPG (OR 3.19 and 2.68, respectively), and BMI (OR 1.72/5 kg/m(2)). In linear regression analysis, HH caused an average 5.09% increase in supine acid exposure (95% CI 0.96-9.22) and an average 3.46% increase in total acid exposure (95% CI 0.82-6.09). Each added year of age caused an average 0.10% increase in upright acid exposure and a 0.09% increase in total acid exposure (95% CI 0.00-0.20 and 0.00-0.18). CONCLUSIONS: BMI predicts IGP, inspiratory GEPG, and expiratory IEP. Age predicts inspiratory IEP and GEPG. Presence of HH is predicted by IGP, GEPG, and BMI. GEPG is not associated with acid exposure. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/18510603/Gastroesophageal_pressure_gradients_in_gastroesophageal_reflux_disease:_relations_with_hiatal_hernia_body_mass_index_and_esophageal_acid_exposure_ L2 - http://Insights.ovid.com/pubmed?pmid=18510603 DB - PRIME DP - Unbound Medicine ER -