Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

Mitchell, David; Derakhshan, Mohammad H.; Wirz, Angela A.; Ballantyne, Stuart; McColl, Kenneth E.L.

doi:10.1053/j.gastro.2017.02.036

Cited by 26 publications

(20 citation statements)

References 17 publications

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“…AO is determined as WC of above 102 cm for men and above 88 cm for women [35]. The WC of the obese population showed a higher risk of BE than that of a healthy population, which was consistent with other studies [36,37]. Interestingly, we observed that the WC of the healthy population also had 1.22 times of BE risk, while we originally supposed that the healthy population with normal WC were not easy to suffer from BE.…”

Section: Discussionsupporting

confidence: 90%

A Meta-Analysis of the Impact of Obesity, Metabolic Syndrome, Insulin Resistance, and Microbiome on the Diagnosis of Barrett’s Esophagus

Jia

Cheng

Chang

et al. 2019

Dig Dis

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Background and Aim: The etiology and pathogenesis of Barrett's esophagus (BE) have been widely studied during recent decades. However, the association between BE and possible risk factors, including abdominal obesity (AO), metabolic syndrome (MetS), insulin resistance (IR), and the microbiome has not reached a consensus and lacks a systematic assessment. The purpose of our study is to evaluate, quantify, and summarize the association between these factors and BE risk. Methods: A systematic search of Pubmed, Embase, and Cochrane Library databases was performed to identify relevant studies before September 2018. Studies were estimated with the OR, the weighted mean difference (WMD), and the 95% CI by using a random effects model. Subgroup analysis and publication bias were also performed. Results: A total of 46 citations were included in the analysis, and 119,273 subjects were analyzed (AO 13, MetS 15, IR 9, and microbiome: 9). The pooled results showed that AO (p < 0.01, OR 1.30, 95% CI 1.11-1.52, I 2 = 31.9%), MetS (p < 0.01, OR 1.68, 95% CI 1.40-2.01, I 2 = 87.6%), and IR (p < 0.01, WMD 0.23, 95% CI 0.11-0.35, I 2 = 55.8%) were all significantly associated with an increased risk of BE, but except for the mi-crobiome (p > 0.05, OR 1.27, 95% CI 0.66-2.43, I 2 = 46.7%). In addition, subgroup analyses were stratified by waist-to-hip ratio, waist circumference, body mass index, diagnosis criteria, strain type, geographical region, and study design, respectively. Moreover, we observed no evidence of publication bias in Egger's and Begg's tests. Conclusions: Our study reveals that AO, MetS, and IR are significantly associated with BE risk, except for the microbiome. The mechanism of BE induced by 3 risk factors should be further explored.

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Section: Discussionsupporting

confidence: 90%

A Meta-Analysis of the Impact of Obesity, Metabolic Syndrome, Insulin Resistance, and Microbiome on the Diagnosis of Barrett’s Esophagus

Jia

Cheng

Chang

et al. 2019

Dig Dis

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“…This mechanism is suggested also by the relatively high frequency of hypertensive contractility in patients with abdominal obesity and those with mild‐moderate oesophago‐gastric junction outlet obstruction . It has been proven by a demonstration that both gastric pressure and peristaltic vigour increase during abdominal compression by a waist belt …”

Section: Discussionmentioning

confidence: 99%

“…This prospective study recruited healthy volunteers by advertisement April 2014 -May 2015. Minimum 10 men and women were required in each age group <35, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] and >50 years to ensure a representative study population. Exclusion criteria included previous abdominal surgery and intake of medications, including opioids, with effects on digestive function.…”

Section: Participantsmentioning

confidence: 99%

“…37 It has been proven by a demonstration that both gastric pressure and peristaltic vigour increase during abdominal compression by a waist belt. 38 The effects of position on oesophageal function highlight the need to apply position specific diagnostic criteria for motility disorders. If this is not done, then ineffective motility will be over-diagnosed in one in three patients investigated in the upright compared to the supine position with similar results for absent peristalsis.…”

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confidence: 99%

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Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Misselwitz

Hollenstein

Bütikofer

et al. 2020

Aliment Pharmacol Ther

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Summary Background Standard high‐resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position. Aims To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders. Methods Seventy‐two healthy volunteers (20‐76 years) and 366 consecutive patients (18‐90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests. Results Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = 0.0007). Similarly, the difference in concordance for the diagnosis of oesophago‐gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = 0.0087). Conclusion Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.

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“…Central obesity measured by abdominal visceral adipose tissue volume, but not BMI or waist circumference, was associated with EE. Recent studies have suggested that running or abdominal compression as a mechanical factor is correlated with GERD, and results of combined high-resolution pH measurement and manometry should be used (11,18). In most clinical situations, direct measurement of the intraabdominal pressure is impractical, so a surrogate measure of intra-gastric pressure was chosen.…”

Section: Discussionmentioning

confidence: 99%

Association Between Erosive Esophagitis and the Anthropometric Index in the General Korean Population

Kim¹

2018

Balkan Med J

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Background: An association between obesity and gastroesophageal reflux disease has been reported. However, previous studies have focused on obesity or central obesity. Aims:To investigate the association of the anthropometric index and endoscopic erosive esophagitis in health checkups of Koreans. Study Design:Case-control study. Methods:A total of 1.207 consecutive subjects (aged 40-80 years) during health checkups underwent upper endoscopy and bioelectrical impedance analysis. We collected anthropometric data by bioelectrical impedance analysis, which consisted of body mass index, percent body fat, muscle mass, and fat mass.Results: Of 1.207 subjects who underwent upper gastrointestinal endoscopy (mean age, 50.55±9 years), 239 (19.8%) had endoscopic erosive esophagitis. In a univariate analysis, the endoscopic erosive esophagitis group was more likely to be a male and had a higher body mass index, muscle mass and fat mass. In logistic regression analysis, only muscle mass remained an independent risk factor for EE after adjustment for both age and gender. Higher muscle mass was associated with increased EE risk (rate ratio: 1.354, 95% confidence interval: 1.206-1.405, p= 0.027). Conclusion: High muscle mass, but body mass index, is an independent risk factor for erosive esophagitis in a population over 40 years of age.

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Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

Cited by 26 publications

References 17 publications

A Meta-Analysis of the Impact of Obesity, Metabolic Syndrome, Insulin Resistance, and Microbiome on the Diagnosis of Barrett’s Esophagus

A Meta-Analysis of the Impact of Obesity, Metabolic Syndrome, Insulin Resistance, and Microbiome on the Diagnosis of Barrett’s Esophagus

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

Association Between Erosive Esophagitis and the Anthropometric Index in the General Korean Population

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