Lower Esophageal Sphincter Pressure and Gastroesophageal Pressure Gradients in Excessively Obese Patients

Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding

“…This study confirms the high prevalence of GERD in the morbidly obese, with symptoms of reflux present in 29% of the patients in the abnormal manometry group and 38% of patients in the normal manometry group. GERD in the morbidly obese may involve increased intra-abdominal pressure that promotes the reflux of gastric contents through an incompetent LES [18]). In one report, esophageal manometry confirmed decreased lower esophageal sphincter (LES) pressures in morbidly obese patients over the age of 35 [12].…”

Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass

“…The mechanism for obesity-induced GERD is not clearly understood. One likely hypothesis is that severe obesity causes chronically increased intraabdominal pressure that promotes the re¯ux of gastric contents through an ineective lower esophageal sphincter [20,31]. The relative pressure gradient from abdomen to chest is therefore exaggerated, promoting gastroesophageal re¯ux.…”

The Pathophysiological Mechanisms of GERD in the Obese Patient

“…This hypothesis originated from the assumption that increase in intraperitoneal and abdominal wall fat mass can increase the intra-abdominal and therefore perigastric pressure [30]. Studies of other hollow organs have confirmed the presence of increased intra-abdominal pressure in patients with central obesity [31].…”