Waist belt and central obesity cause partial hiatus hernia and short-segment acid reflux in asymptomatic volunteers.
OBJECTIVE
There is a high incidence of inflammation and metaplasia at the gastro-oesophageal junction (GOJ) in asymptomatic volunteers. Additionally, the majority of patients with GOJ adenocarcinomas have no history of reflux symptoms. We report the effects of waist belt and increased waist circumference (WC) on the physiology of the GOJ in asymptomatic volunteers.


METHODS
12 subjects with normal and 12 with increased WC, matched for age and gender were examined fasted and following a meal and with waist belts on and off. A magnet was clipped to the squamo-columnar junction (SCJ). Combined assembly of magnet-locator probe, 12-channel pH catheter and 36-channel manometer was passed.


RESULTS
The waist belt and increased WC were each associated with proximal displacement of SCJ within the diaphragmatic hiatus (relative to upper border of lower oesophageal sphincter (LOS), peak LOS pressure point and pressure inversion point, and PIP (all p<0.05). The magnitude of proximal migration of SCJ during transient LOS relaxations was reduced by 1.6-2.6 cm with belt on versus off (p=0.01) and in obese versus non-obese (p=0.04), consistent with its resting position being already proximally displaced. The waist belt, but not increased WC, was associated with increased LOS pressure (vs intragastric pressure) and movement of pH transition point closer to SCJ. At 5 cm above upper border LOS, the mean % time pH <4 was <4% in all studied groups. Acid exposure 0.5-1.5 cm above SCJ was increased, with versus without, belt (p=0.02) and was most marked in obese subjects with belt.


CONCLUSIONS
Our findings indicate that in asymptomatic volunteers, waist belt and central obesity cause partial hiatus herniation and short-segment acid reflux. This provides a plausible explanation for the high incidence of inflammation and metaplasia and occurrence of neoplasia at the GOJ in subjects without a history of reflux symptoms.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia.
Yeong Yeh
YY
Lee
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Angela A
AA
Wirz
Department of Bioengineering, University of Strathclyde, Glasgow, UK.
James G H
JG
Whiting
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Elaine V
EV
Robertson
Medical Devices Unit, Department of Clinical Physics, Southern General Hospital, Glasgow, UK.
Donald
D
Smith
Medical Devices Unit, Department of Clinical Physics, Southern General Hospital, Glasgow, UK.
Alexander
A
Weir
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Andrew W
AW
Kelman
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Mohammad H
MH
Derakhshan
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Kenneth E L
KE
McColl
D000328:Adult; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D003020:Clothing / Q000009:adverse effects*; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008365:Manometry; D056128:Obesity, Abdominal / Q000503:physiopathology*; D011312:Pressure / Q000009:adverse effects*; D055105:Waist Circumference
Gastroesophageal Reflux Disease; Gastrointestinal Cancer; Gastrointestinal Motility