Abdominal compression by waist belt aggravates gastroesophageal reflux, primarily by impairing esophageal clearance

Mitchell, D. R., Derakhshan, M. H., Wirz, A. A., Ballantyne, S. A. and 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)

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Abstract

Background & Aims: Central obesity promotes gastroesophageal reflux and this 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); their median age was 56 years and their median body mass index, 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 gastrointestinal symptoms was assessed, and measurements of height, weight, 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 15mmHg. 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wirz, Sister Angela and Derakhshan, Dr Mohammad and Ballantyne, Dr Stuart and McColl, Professor Kenneth and Mitchell, Rev David
Authors: Mitchell, D. R., Derakhshan, M. H., Wirz, A. A., Ballantyne, S. A., and McColl, K. E.L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Gastroenterology
Publisher:Elsevier
ISSN:0016-5085
ISSN (Online):1528-0012
Published Online:03 March 2017
Copyright Holders:Copyright © 2017 Elsevier
First Published:First published in Gastroenterology 152(8):1881-1888
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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