Abstract
Chronic (obesity) and acute intraabdominal, pressure increases appear to favor gastroesophageal reflux, but the mechanism is not completely understood. We hypothesized that it could be due to an alteration in the resistance gradient between the stomach and the gastroesophageal junction, even increasing intragastric resistance above resistance at the gastroesophageal junction. Hence, we used a pneumatic resistometer to measure gastric and gastroesophageal resistance to flow in 11 lean healthy controls and eight morbidly obese individuals without gastroesophageal reflux disease. Resistance was quantified at rest and during acute intraabdominal pressure increases, both in the recumbent and sitting positions. We found that gastroesophageal junction resistance was higher than gastric resistance in lean as well as in obese subjects (P<0.001). In obese individuals both gastric and gastroesophageal junction resistance were increased (P<0.001), thus a normal gastric-gastroesophageal junction resistance gradient was maintained. Body position did not modify resistance. Acute increases in intraabdominal pressure decreased the gastric-gastroesophageal junction resistance gradient similarly in obese and lean subjects. We conclude that obesity by itself does not appear to predispose to gastroesophageal reflux, but it creates intraabdominal conditions that may favor reflux whenever the gastroesophageal barrier becomes weakened.
Similar content being viewed by others
References
Cohen S, Harris LD: The lower esophageal sphincter. Gastroenterology 63:1066–1073, 1972
Castell DO: The lower esophageal sphincter. Physiologic and clinical aspects. Ann Intern Med 83:390–401, 1975
Haddad JK: Relation of gastroesophageal reflux to yield sphincter pressures. Gastroenterology 58:175–184, 1970
DeMeester TR, Wernly JA, Bryant GH, Little AG, Skinner DB: Clinical andin vitro analysis of determinants of gastroesophageal competence. Am J Surg 137:39–46, 1979
Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980
Dent J, Holloway RH, Toouli J, Doods NJ: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 29:1020–1028, 1988
Lind JF, Warrian WG, Wankling WJ: Responses of the gastroesophageal junction zone to increases in abdominal pressure. Can J Surg 9:32–38, 1966
Backman L, Stranström L, Lindahl J, Melcher A: Manometric studies of lower esophageal sphincter in extreme obesity. Acta Chir Scand 149:193–197, 1983
Mearin F, Azpiroz F, Malagelada J-R: Measurement of resistance to flow across the antroduodenal area during fasting. Am J Physiol 250:G773-G780, 1986
Dent J: A new technique for continuous sphincter pressure measurement. Gastroenterology 71:263–267, 1976
Azpiroz F, Malagelada J-R: Physiological variations in canine gastric tone measured by an electronic barostat. Am J Physiol 248:G229-G237, 1985
Cronk CE, Roche AF: Race and sex specific references data for triceps and subcapsular skinfolds and weight/stature. Am J Clin Nutr 35:347–354, 1982
Mearin F, Azpiroz F, Malagelada J-R: Pyloric contribution to antroduodenal resistance to flow in the conscious dog. Am J Physiol 253:G72-G78, 1987
Mearin F, Azpiroz F, Malagelada J-R, Zinsmeister A-R: Antroduodenal resistance to flow in the control of duodenogastric bile reflux during fasting. Gastroenterology 93:1026–1033, 1987
Mearin F, Vilardell M, Malagelada J-R: Resistance to flow at the lower esophageal sphincter (LES) and adjacent regions in health and scleroderma. Gastroenterology 94:A297, 1988 (abstract)
Mearin F, Zacchi P, Arias A, Malagelada J-R: Quantification of resistance to flow at the esophagogastric junction in man. J Gastrointest Motil 2:287–295, 1990
Funch-Jense P, Oster MJ: Influence of food intake and postural changes on gastroesophageal sphincter pressure in patients with reflux esophagitis and in controls. Scand J Gastroenterol 17:279–281, 1973
Babka JC, Hager GW, Castell DO: The effect of body position on lower esophageal sphincter pressure. Am J Dig Dis 18:4412, 1973
Dodds WJ, Hogan WJ, Miller WN, Stef JJ, Arndorfer RC, Lydon SB: Effect of increased abdominal pressure on lower esophageal sphincter pressure. Am J Dig Dis 20:298–308, 1975
Janish HD, Weihrauch TR, Hampel KE: Is abdominal compression a useful stimulation test for analysis of lower esophageal sphincter function? Dig Dis Sci 29:689–695, 1984
Mercer CD, Wren SF, DaCosta LR, Beck IT: Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med Clin Exp Theor 18(34):1354–1356, 1987
Samelson SL, Weier HF, Bombeck CT, Siewert JR, Ludke FE, Hoelscher AH, Abuabara SF, Nyhus. New concepts in surgical treatment of gastroesophageal reflux. Ann Surg 197:254–259, 1983
Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982
Author information
Authors and Affiliations
Additional information
This study was supported by the Spanish Institute of Health (Fondo de Investigaciones Sanitarias).
Rights and permissions
About this article
Cite this article
Zacchi, P., Mearin, F., Humbert, P. et al. Effect of obesity on gastroesophageal resistance to flow in man. Digest Dis Sci 36, 1473–1480 (1991). https://doi.org/10.1007/BF01296818
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296818