Disruption of the gastroesophageal junction by central obesity and waist belt: role of raised intra-abdominal pressure

Lee, Y. Y. and McColl, K. E. L. (2015) Disruption of the gastroesophageal junction by central obesity and waist belt: role of raised intra-abdominal pressure. Diseases of the Esophagus, 28(4), pp. 318-325. (doi: 10.1111/dote.12202) (PMID:24575877)

Abstract

Obesity is a major reason for the recent increase in incidence of reflux disease and cancers at the distal esophagus and gastroesophageal junction (GOJ) and is mediated through a rise in the intra-abdominal pressure (IAP) but the exact mechanisms are unclear. Raised IAP from obesity and with application of waist belt produces mechanical distortion of the GOJ through formation of partial hiatus hernia. Even though there is no trans-sphincteric acid reflux, there is increased ingress of acid into the lower sphincter (intra-sphincteric reflux) as a consequence of raised IAP. In addition, short segment acid reflux is more evident in obese subjects with a belt on. Acid pocket is also enlarged in hiatus hernia, and acts as a reservoir of acid available to reflux whenever the sphincter fails. Above mechanisms may explain the common occurrence of cardiac lengthening and inflammation found in asymptomatic obese subjects. The inflamed cardia is also immunohistochemically similar to non-intestinal Barrett's mucosa, which is of etiological importance for cancers at the GOJ. Interventions that can reduce the mechanical distortion and acid exposure at the GOJ, including diet, exercise, drugs, sphincter augmentation therapy, and surgery, are clinically relevant in the treatment of gastroesophageal reflux disease but more data are needed whether if these strategies are also effective in preventing cancer. As a conclusion, raised IAP produces silent mechanical disruption of the GOJ, which may explain the high occurrence of cancers in this region and it is potentially reversible with early interventions.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McColl, Professor Kenneth
• Authors: Lee, Y. Y., and McColl, K. E. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Diseases of the Esophagus
• ISSN: 1120-8694

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
51025	1	Does intra-abdominal fat accumulation induce intrasphincteric acid reflux and metaplasia at gastro-oesophageal junction?	Kenneth Mccoll	Scottish Executive Health Department (SEHHD-CSO)	CZB/4/709	RI CARDIOVASCULAR & MEDICAL SCIENCES