In a prospective study, we found a standardized protocol for diaphragmatic breathing to reduce belching and PPI-refractory gastroesophageal reflux symptoms, and increase QoL in patients with PPI-refractory GERD with belching-especially those with excessive SGB.

Background & Aims Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histological score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation and dysplasia. Results All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. GEJ fat area (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.3–27.7; P=.02), visceral fat area (OR, 4.9; 95% CI, 1.0–22.8; P=.04) and abdominal circumference (OR=9.1; 95% CI, 1.4–57.2; P=0.02) were associated with BE, independent of BMI. Subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared to those without, P=.02) and high-grade dysplasia (HGD) (compared to those without, P=.01), independent of BMI. Conclusions GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and HGD in BE subjects, independent of BMI. Visceral fat might therefore promote esophageal metaplasia and dysplasia.

Anatomical causes are present in 15% of EGJOO. Evaluation is warranted especially in patients presenting with dysphagia. Esophageal biopsies, barium swallows, computed tomography scans, and endoscopic ultrasound are complementary in EGJOO evaluation. In patients with non-obstructive symptoms and no anatomical etiologies, monitoring for spontaneous resolution is an option.