title: Leg raise increases pressure in lower and upper esophageal sphincter among patients with gastroesophageal reflux disease.
abstract: The purpose of this study was to determine the relation between posturally increased intra-abdominal pressure and lower/upper esophageal sphincter pressure changes in patients with gastroesophageal reflux disease. We used high resolution manometry to measure pressure changes in lower and upper esophageal sphincter during bilateral leg rise. We also examined whether the rate of lower and upper esophageal sphincter pressure would increase during leg raise differentially in individuals with versus without normal resting pressure. Fifty eight patients with gastroesophageal reflux disease participated in the study. High resolution manometry was performed in relaxed supine position, then lower and upper esophageal sphincter pressure was measured. Finally, the subjects were instructed to keep their legs lifted while performing 90-degree flexion at the hips and knees and the pressure was measured again. Paired t-test and independent samples t-test were used. There was a significant increase in both lower (P < 0.001) and upper esophageal sphincter pressure (P = 0.034) during leg raise compared to the initial resting position. Individuals with initially higher pressure in lower esophageal sphincter (>10 mmHg) exhibited a greater pressure increase during leg raise than those with initially lower pressure (pressure ≤10 mmHg; P = 0.002). Similarly individuals with higher resting upper esophageal sphincter pressure (>44 mmHg) showed a greater pressure increase during leg raise than those with lower resting pressure (≤44 mmHg; P < 0.001). The results illustrate the influence of postural leg activities on intraesophageal pressure in patients with gastroesophageal reflux disease, indicating by means of high resolution manometry that diaphragmatic postural and sphincter function are likely interrelated in this population.
authors.affiliation: Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Bitnar
authors.affiliation: Department of Internal Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Stovicek
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, FL, USA; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Andel
authors.affiliation: Department of Statistics and Probability, Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Arlt
authors.affiliation: Department of Statistics and Probability, Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Arltova
authors.affiliation: Chirurgie Generale Viscerale et Digestive, Centre Hospitalier Émile Roux, France.
authors.forename: M
authors.initials: M
authors.lastname: Smejkal
authors.affiliation: Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Kolar
authors.affiliation: Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. Electronic address: alenamudr@me.com.
authors.forename: A
authors.initials: A
authors.lastname: Kobesova
mesh_terms: D000328:Adult; D000368:Aged; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D049631:Esophageal Sphincter, Upper / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D007866:Leg / Q000502:physiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D011187:Posture
keywords: Diaphragm; Esophageal pressure; Gastroesophageal reflux disease; High resolution manometry