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Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa.
Gastroenterology 2013; 145(4):730-9G

Abstract

BACKGROUND & AIMS

In the West, a substantial proportion of subjects with adenocarcinoma of the gastric cardia and gastroesophageal junction have no history of reflux. We studied the gastroesophageal junction in asymptomatic volunteers with normal and large waist circumferences (WCs) to determine if central obesity is associated with abnormalities that might predispose individuals to adenocarcinoma.

METHODS

We performed a study of 24 healthy, Helicobacter pylori-negative volunteers with a small WC and 27 with a large WC. Abdominal fat was quantified by magnetic resonance imaging. Jumbo biopsy specimens were taken across the squamocolumnar junction (SCJ). High-resolution pH-metry (12 sensors) and manometry (36 sensors) were performed in upright and supine subjects before and after a meal; the SCJ was visualized fluoroscopically.

RESULTS

The cardiac mucosa was significantly longer in the large WC group (2.5 vs 1.75 mm; P = .008); its length correlated with intra-abdominal (R = 0.35; P = .045) and total abdominal (R = 0.37; P = .034) fat. The SCJ was closer to the upper border of the lower esophageal sphincter (LES) in subjects with a large WC (2.77 vs 3.54 cm; P = .02). There was no evidence of excessive reflux 5 cm above the LES in either group. Gastric acidity extended more proximally within the LES in the large WC group, compared with the upper border (2.65 vs 4.1 cm; P = .027) and peak LES pressure (0.1 cm proximal vs 2.1 cm distal; P = .007). The large WC group had shortening of the LES, attributable to loss of the distal component (total LES length, 3 vs 4.5 cm; P = .043).

CONCLUSIONS

Central obesity is associated with intrasphincteric extension of gastric acid and cardiac mucosal lengthening. The latter might arise through metaplasia of the most distal esophageal squamous epithelium and this process might predispose individuals to adenocarcinoma.

Authors+Show Affiliations

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23796455

Citation

Robertson, Elaine V., et al. "Central Obesity in Asymptomatic Volunteers Is Associated With Increased Intrasphincteric Acid Reflux and Lengthening of the Cardiac Mucosa." Gastroenterology, vol. 145, no. 4, 2013, pp. 730-9.
Robertson EV, Derakhshan MH, Wirz AA, et al. Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa. Gastroenterology. 2013;145(4):730-9.
Robertson, E. V., Derakhshan, M. H., Wirz, A. A., Lee, Y. Y., Seenan, J. P., Ballantyne, S. A., ... McColl, K. E. (2013). Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa. Gastroenterology, 145(4), pp. 730-9. doi:10.1053/j.gastro.2013.06.038.
Robertson EV, et al. Central Obesity in Asymptomatic Volunteers Is Associated With Increased Intrasphincteric Acid Reflux and Lengthening of the Cardiac Mucosa. Gastroenterology. 2013;145(4):730-9. PubMed PMID: 23796455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa. AU - Robertson,Elaine V, AU - Derakhshan,Mohammad H, AU - Wirz,Angela A, AU - Lee,Yeong Yeh, AU - Seenan,John Paul, AU - Ballantyne,Stuart A, AU - Hanvey,Scott L, AU - Kelman,Andrew W, AU - Going,James J, AU - McColl,Kenneth E L, Y1 - 2013/06/22/ PY - 2013/03/11/received PY - 2013/06/07/revised PY - 2013/06/18/accepted PY - 2013/6/26/entrez PY - 2013/6/26/pubmed PY - 2013/12/16/medline KW - BMI KW - Cancer Risk KW - Cardia Histology KW - GEJ KW - GI KW - IGP KW - IQR KW - Intrasphincteric Reflux KW - LES KW - MRI KW - Overweight KW - PIP KW - SCJ KW - TLESRs KW - WC KW - body mass index KW - gastroesophageal junction KW - gastrointestinal KW - interquartile range KW - intragastric pressure KW - lower esophageal sphincter KW - magnetic resonance imaging KW - pressure inversion point KW - squamocolumnar junction KW - transient lower esophageal sphincter relaxations KW - waist circumference SP - 730 EP - 9 JF - Gastroenterology JO - Gastroenterology VL - 145 IS - 4 N2 - BACKGROUND & AIMS: In the West, a substantial proportion of subjects with adenocarcinoma of the gastric cardia and gastroesophageal junction have no history of reflux. We studied the gastroesophageal junction in asymptomatic volunteers with normal and large waist circumferences (WCs) to determine if central obesity is associated with abnormalities that might predispose individuals to adenocarcinoma. METHODS: We performed a study of 24 healthy, Helicobacter pylori-negative volunteers with a small WC and 27 with a large WC. Abdominal fat was quantified by magnetic resonance imaging. Jumbo biopsy specimens were taken across the squamocolumnar junction (SCJ). High-resolution pH-metry (12 sensors) and manometry (36 sensors) were performed in upright and supine subjects before and after a meal; the SCJ was visualized fluoroscopically. RESULTS: The cardiac mucosa was significantly longer in the large WC group (2.5 vs 1.75 mm; P = .008); its length correlated with intra-abdominal (R = 0.35; P = .045) and total abdominal (R = 0.37; P = .034) fat. The SCJ was closer to the upper border of the lower esophageal sphincter (LES) in subjects with a large WC (2.77 vs 3.54 cm; P = .02). There was no evidence of excessive reflux 5 cm above the LES in either group. Gastric acidity extended more proximally within the LES in the large WC group, compared with the upper border (2.65 vs 4.1 cm; P = .027) and peak LES pressure (0.1 cm proximal vs 2.1 cm distal; P = .007). The large WC group had shortening of the LES, attributable to loss of the distal component (total LES length, 3 vs 4.5 cm; P = .043). CONCLUSIONS: Central obesity is associated with intrasphincteric extension of gastric acid and cardiac mucosal lengthening. The latter might arise through metaplasia of the most distal esophageal squamous epithelium and this process might predispose individuals to adenocarcinoma. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/23796455/Central_obesity_in_asymptomatic_volunteers_is_associated_with_increased_intrasphincteric_acid_reflux_and_lengthening_of_the_cardiac_mucosa_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(13)00940-2 DB - PRIME DP - Unbound Medicine ER -