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The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients.
Eur J Gastroenterol Hepatol 2010; 22(4):404-11EJ

Abstract

BACKGROUND AND AIMS

The relationship between gastro-oesophageal pressure gradient (GOPG), sliding hiatal hernia (SHH) and gastro-oesophageal reflux disease (GORD) is under investigation. We assessed whether GOPG and SHH are predictors of pathological reflux in severely obese patients.

METHODS

Ninety-four consecutive patients were prospectively studied with oesophageal manometry, 24-h pH monitoring, upper gastrointestinal endoscopy and barium swallow X-ray. Inspiratory and expiratory GOPGs were measured at manometry testing, whereas SHH was characterized by X-ray. Patients were classified as having physiological or pathological reflux depending on pH monitoring. Patients with oesophagitis but normal pH testing were excluded.

RESULTS

Eighty-nine patients composed the study sample (25 men, 38.3+/-11.1 years; BMI 45+/-6.9 kg/m). Sixty-two patients (70%) had pathological reflux, whereas 27 patients (30%) had physiological reflux. Pathological reflux was predicted either by inspiratory GOPG [prevalence ratio (PR) =1.05; 95% confidence interval (CI): 1.03-1.08; P<0.001] or by expiratory GOPG (PR=1.07; 95% CI: 1.03-1.11; P=0.001). Accordingly, an increment of 1 mmHg in inspiratory and expiratory GOPGs raises the risk of pathological reflux in 5 and 7%, respectively. Pathological reflux was also predicted by SHH (PR: 1.54, 95% CI: 1.19-2.00; P=0.001), which increases the risk of abnormal reflux in 54%.

CONCLUSION

In severely obese patients, either inspiratory GOPG, expiratory GOPG or SHH are predictors of pathological reflux. These findings give pathophysiological support to the high prevalence of GORD in this population.

Authors+Show Affiliations

Department of Clinical Research, GASTROBESE, Passo Fundo-RS, Brazil. FernandoFornari@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20110819

Citation

Fornari, Fernando, et al. "The Role of Gastro-oesophageal Pressure Gradient and Sliding Hiatal Hernia On Pathological Gastro-oesophageal Reflux in Severely Obese Patients." European Journal of Gastroenterology & Hepatology, vol. 22, no. 4, 2010, pp. 404-11.
Fornari F, Madalosso CA, Farré R, et al. The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. Eur J Gastroenterol Hepatol. 2010;22(4):404-11.
Fornari, F., Madalosso, C. A., Farré, R., Gurski, R. R., Thiesen, V., & Callegari-Jacques, S. M. (2010). The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. European Journal of Gastroenterology & Hepatology, 22(4), pp. 404-11. doi:10.1097/MEG.0b013e328332f7b8.
Fornari F, et al. The Role of Gastro-oesophageal Pressure Gradient and Sliding Hiatal Hernia On Pathological Gastro-oesophageal Reflux in Severely Obese Patients. Eur J Gastroenterol Hepatol. 2010;22(4):404-11. PubMed PMID: 20110819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. AU - Fornari,Fernando, AU - Madalosso,Carlos A S, AU - Farré,Ricard, AU - Gurski,Richard R, AU - Thiesen,Victor, AU - Callegari-Jacques,Sidia M, PY - 2010/1/30/entrez PY - 2010/1/30/pubmed PY - 2010/7/9/medline SP - 404 EP - 11 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 22 IS - 4 N2 - BACKGROUND AND AIMS: The relationship between gastro-oesophageal pressure gradient (GOPG), sliding hiatal hernia (SHH) and gastro-oesophageal reflux disease (GORD) is under investigation. We assessed whether GOPG and SHH are predictors of pathological reflux in severely obese patients. METHODS: Ninety-four consecutive patients were prospectively studied with oesophageal manometry, 24-h pH monitoring, upper gastrointestinal endoscopy and barium swallow X-ray. Inspiratory and expiratory GOPGs were measured at manometry testing, whereas SHH was characterized by X-ray. Patients were classified as having physiological or pathological reflux depending on pH monitoring. Patients with oesophagitis but normal pH testing were excluded. RESULTS: Eighty-nine patients composed the study sample (25 men, 38.3+/-11.1 years; BMI 45+/-6.9 kg/m). Sixty-two patients (70%) had pathological reflux, whereas 27 patients (30%) had physiological reflux. Pathological reflux was predicted either by inspiratory GOPG [prevalence ratio (PR) =1.05; 95% confidence interval (CI): 1.03-1.08; P<0.001] or by expiratory GOPG (PR=1.07; 95% CI: 1.03-1.11; P=0.001). Accordingly, an increment of 1 mmHg in inspiratory and expiratory GOPGs raises the risk of pathological reflux in 5 and 7%, respectively. Pathological reflux was also predicted by SHH (PR: 1.54, 95% CI: 1.19-2.00; P=0.001), which increases the risk of abnormal reflux in 54%. CONCLUSION: In severely obese patients, either inspiratory GOPG, expiratory GOPG or SHH are predictors of pathological reflux. These findings give pathophysiological support to the high prevalence of GORD in this population. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/20110819/The_role_of_gastro_oesophageal_pressure_gradient_and_sliding_hiatal_hernia_on_pathological_gastro_oesophageal_reflux_in_severely_obese_patients_ L2 - http://Insights.ovid.com/pubmed?pmid=20110819 DB - PRIME DP - Unbound Medicine ER -