Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa

Robertson, E.V., Derakhshan, M.H., Wirz, A.A., Lee, Y.Y., Seenan, J.P., Ballantyne, S.A., Hanvey, S.S., Kelman, A.W., Going, J.J. and McColl, K.E.L. (2013) Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa. Gastroenterology, 145(4), pp. 730-739. (doi: 10.1053/j.gastro.2013.06.038)

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Abstract

<p>Background and 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 circumference (WC) to determine if central obesity is associated with abnormalities that might predispose individuals to adenocarcinoma.</p> <p>Methods: We performed a study of 24 healthy, Helicobacter pylori-negative volunteers with small and 27 with large WC. Abdominal fat was quantified by magnetic resonance imaging. Orientated jumbo biopsies were taken across the squamo-columnar 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.</p> <p>Results: The cardiac mucosa was significantly longer in the large WC group (2.5 mm vs 1.75 mm; P=.008); its length correlated with intra (R=.35, P=.045) and total (R=0.37, P=.034) abdominal fat. The SCJ was closer to the upper border of the lower esophageal sphincter (LES) in subjects with large WC (2.77 cm 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 cm vs 4.1cm, 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 cm vs 4.5 cm, P=.043).</p> <p>Conclusions: Central obesity is associated with intra-sphincteric 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.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Derakhshan, Dr Mohammad and Ballantyne, Dr Stuart and Lee, Dr Yeong and McColl, Professor Kenneth and Robertson, Dr Elaine and Going, Dr James
Authors: Robertson, E.V., Derakhshan, M.H., Wirz, A.A., Lee, Y.Y., Seenan, J.P., Ballantyne, S.A., Hanvey, S.S., Kelman, A.W., Going, J.J., and McColl, K.E.L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Gastroenterology
ISSN:0016-5085
ISSN (Online):1528-0012

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