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Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance.
Gastroenterology 2017; 152(8):1881-1888G

Abstract

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.

Authors+Show Affiliations

Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.Department of Clinical Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK.Section of Gastroenterology, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK. Electronic address: Kenneth.mccoll@glasgow.ac.uk.

Pub Type(s)

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

Language

eng

PubMed ID

28267445

Citation

Mitchell, David R., et al. "Abdominal Compression By Waist Belt Aggravates Gastroesophageal Reflux, Primarily By Impairing Esophageal Clearance." Gastroenterology, vol. 152, no. 8, 2017, pp. 1881-1888.
Mitchell DR, Derakhshan MH, Wirz AA, et al. Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance. Gastroenterology. 2017;152(8):1881-1888.
Mitchell, D. R., Derakhshan, M. H., Wirz, A. A., Ballantyne, S. A., & McColl, K. E. L. (2017). Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance. Gastroenterology, 152(8), pp. 1881-1888. doi:10.1053/j.gastro.2017.02.036.
Mitchell DR, et al. Abdominal Compression By Waist Belt Aggravates Gastroesophageal Reflux, Primarily By Impairing Esophageal Clearance. Gastroenterology. 2017;152(8):1881-1888. PubMed PMID: 28267445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance. AU - Mitchell,David R, AU - Derakhshan,Mohammad H, AU - Wirz,Angela A, AU - Ballantyne,Stuart A, AU - McColl,Kenneth E L, Y1 - 2017/03/03/ PY - 2016/11/07/received PY - 2017/02/23/revised PY - 2017/02/24/accepted PY - 2017/3/8/pubmed PY - 2017/8/15/medline PY - 2017/3/8/entrez KW - Barrett’s Esophagus KW - Central Obesity KW - Lower Esophageal Sphincter KW - Transient Lower Esophageal Sphincter Relaxations SP - 1881 EP - 1888 JF - Gastroenterology JO - Gastroenterology VL - 152 IS - 8 N2 - 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. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/28267445/Abdominal_Compression_by_Waist_Belt_Aggravates_Gastroesophageal_Reflux_Primarily_by_Impairing_Esophageal_Clearance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(17)30231-7 DB - PRIME DP - Unbound Medicine ER -