Gastroesophageal pressure gradients in gastroesophageal reflux disease: Relations with hiatal hernia, body mass index, and esophageal acid exposure

被引:111
作者
de Vries, Durk R. [1 ]
Van Herwaarden, Margot A. [1 ]
Smout, Andre J. P. M. [1 ]
Samsom, Melvin [1 ]
机构
[1] Univ Utrecht, Med Ctr, Dept Gastroenterol & Hepatol, NL-3508 GA Utrecht, Netherlands
关键词
D O I
10.1111/j.1572-0241.2008.01909.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: The roles of intragastric pressure (IGP), intraesophageal pressure (IEP), gastroesophageal pressure gradient (GEPG), and body mass index (BMI) in the pathophysiology of gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are only partly understood. METHODS: In total, 149 GERD patients underwent stationary esophageal manometry, 24-h pH-metry, and endoscopy. RESULTS: One hundred three patients had HH. Linear regression analysis showed that each kilogram per square meter of BMI caused a 0.047-kPa increase in inspiratory IGP (95% confidence interval [CI] 0.026-0.067) and a 0.031-kPa increase in inspiratory GEPG (95% CI 0.007-0.055). Each kilogram per square meter of BMI caused expiratory IGP to increase with 0.043 kPa (95% CI 0.025-0.060) and expiratory IEP with 0.052 kPa (95% CI 0.027-0.077). Each added year of age caused inspiratory IEP to decrease by 0.008 kPa (95% CI -0.015--0.001) and inspiratory GEPG to increase by 0.008 kPa (95% CI 0.000-0.015). In binary logistic regression analysis, HH was predicted by inspiratory and expiratory IGP (odds ratio [OR] 2.93 and 2.62, respectively), inspiratory and expiratory GEPG (OR 3.19 and 2.68, respectively), and BMI (OR 1.72/5 kg/m(2)). In linear regression analysis, HH caused an average 5.09% increase in supine acid exposure (95% CI 0.96-9.22) and an average 3.46% increase in total acid exposure (95% CI 0.82-6.09). Each added year of age caused an average 0.10% increase in upright acid exposure and a 0.09% increase in total acid exposure (95% CI 0.00-0.20 and 0.00-0.18). CONCLUSIONS: BMI predicts IGP, inspiratory GEPG, and expiratory IEP. Age predicts inspiratory IEP and GEPG. Presence of HH is predicted by IGP, GEPG, and BMI. GEPG is not associated with acid exposure.
引用
收藏
页码:1349 / 1354
页数:6
相关论文
共 26 条
[1]   Gastro-oesophageal reflux of liquids and gas during transient lower oesophageal sphincter relaxations [J].
Bredenoord, A. J. ;
Weusten, B. L. A. M. ;
Timmer, R. ;
Smout, A. J. P. M. .
NEUROGASTROENTEROLOGY AND MOTILITY, 2006, 18 (10) :888-893
[2]   Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux [J].
Bredenoord, AJ ;
Weusten, BLAM ;
Timmer, R ;
Smout, AJPM .
GASTROENTEROLOGY, 2006, 130 (02) :334-340
[3]   The gastro-oesophageal pressure inversion point revisited [J].
Bredenoord, AJ ;
Weusten, BLAM ;
Roelofs, JMM ;
Smout, AJPM .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 2003, 38 (08) :812-818
[4]   Abdominal obesity and body mass index as risk factors for Barrett's esophagus [J].
Corley, Douglas A. ;
Kubo, Al ;
Levin, Theodore R. ;
Block, Gladys ;
Habel, Laurel ;
Zhao, Wei ;
Leighton, Pat ;
Quesenberry, Charles ;
Rumore, Greg J. ;
Buffler, Patricia A. .
GASTROENTEROLOGY, 2007, 133 (01) :34-41
[5]   Semicontinuous intra-abdominal pressure measurement using an intragastric Compliance catheter [J].
De Waele, Jan J. ;
Berrevoet, F. ;
Reyntjens, K. ;
Pletinckx, P. ;
De laet, I. ;
Hoste, E. .
INTENSIVE CARE MEDICINE, 2007, 33 (07) :1297-1300
[6]   Epidemiology of gastrooesophageal reflux disease: A systematic review [J].
Dent, J ;
El-Serag, HB ;
Wallander, MA ;
Johansson, S .
GUT, 2005, 54 (05) :710-717
[7]   EFFECT OF INCREASED INTRAABDOMINAL PRESSURE ON LOWER ESOPHAGEAL SPHINCTER PRESSURE [J].
DODDS, WJ ;
HOGAN, WJ ;
MILLER, WN ;
STEF, JJ ;
ARNDORFER, RC ;
LYDON, SB .
AMERICAN JOURNAL OF DIGESTIVE DISEASES, 1975, 20 (04) :298-308
[8]   Obesity increases oesophageal acid exposure [J].
El-Serag, Hashem B. ;
Ergun, Gulchin A. ;
Pandolfino, John ;
Fitzgerald, Stephanie ;
Tran, Thomas ;
Kramer, Jennifer R. .
GUT, 2007, 56 (06) :749-755
[9]   Anthropometric correlates of intragastric pressure [J].
El-Serag, Hashem B. ;
Tran, Thomas ;
Richardson, Peter ;
Ergun, Gulchin .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 2006, 41 (08) :887-891
[10]   Effect of hiatal hernia on proximal oesophageal acid clearance in gastro-oesophageal reflux disease patients [J].
Emerenziani, S ;
Habib, FI ;
Ribolsi, M ;
Caviglia, R ;
Guarino, MPL ;
Petitti, T ;
Cicala, M .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2006, 23 (06) :751-757