Skip to main content
Log in

Visceral Obesity is Associated with Thoraco-abdominal Pressure Gradient (TAPG) and Gastroesophageal Reflux Disease

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Sharara AI, Rustom LBO, Bou Daher H, Rimmani HH, Shayto RH, Minhem M, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis. 2019;51:1375–9. https://doi.org/10.1016/j.dld.2019.04.010.

    Article  PubMed  Google Scholar 

  2. El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR. Obesity increases oesophageal acid exposure. Gut. 2007;56:749–55. https://doi.org/10.1136/gut.2006.100263.

    Article  PubMed  Google Scholar 

  3. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80. https://doi.org/10.1136/gutjnl-2012-304269.

    Article  PubMed  Google Scholar 

  4. Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian H. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis. Ann Surg. 2020;271:257–65. https://doi.org/10.1097/SLA.0000000000003275.

    Article  PubMed  Google Scholar 

  5. Admella V, Lazzara C, Sobrino L, Acrich E, Biondo S, Pujol-Gebellí J, et al. Patient-Reported Outcomes and Quality of Life After Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Cross-Sectional Study with 283 Patients from a Single Institution. Obes Surg. 2023;33:1754–63. https://doi.org/10.1007/S11695-023-06554-X.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nehmeh WA, Baratte C, Rives-Lange C, Martineau C, Boullenois H, Krivan S, et al. Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass. Obes Surg. 2021;31:4717–23. https://doi.org/10.1007/S11695-021-05542-3.

    Article  PubMed  Google Scholar 

  7. Hoshino M, Sundaram A, Mittal SK. Role of the lower esophageal sphincter on acid exposure revisited with high-resolution manometry. J Am Coll Surg. 2011;213:743–50. https://doi.org/10.1016/j.jamcollsurg.2011.09.002.

    Article  PubMed  Google Scholar 

  8. Gor P, Li Y, Munigala S, Patel A, Bolkhir A, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2016;29:820–8. https://doi.org/10.1111/dote.12389.

    Article  CAS  PubMed  Google Scholar 

  9. Tolone S, De Bortoli N, Marabotto E, de Cassan C, Bodini G, Roman S, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value. Neurogastroenterol Motil. 2015;27:1423–31. https://doi.org/10.1111/nmo.12638.

    Article  CAS  PubMed  Google Scholar 

  10. Yen HH, Tseng PH, Shih MC, Yang PJ, Lin MT, Lee PC. Derangement of esophageal anatomy and motility in morbidly obese patients: a prospective study based on high-resolution impedance manometry. Surg Obes Relat Dis. 2020;16:2006–15. https://doi.org/10.1016/j.soard.2020.07.023.

    Article  PubMed  Google Scholar 

  11. Ayazi S, DeMeester SR, Hsieh CC, Zehetner J, Sharma G, Grant KS, et al. Thoraco-abdominal pressure gradients during the phases of respiration contribute to gastroesophageal reflux disease. Dig Dis Sci. 2011;56:1718–22. https://doi.org/10.1007/s10620-011-1694-y.

    Article  PubMed  Google Scholar 

  12. Kaess BM, Pedley A, Massaro JM, Murabito J, Hoffmann U, Fox CS. The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk. Diabetologia. 2012;55:2622–30. https://doi.org/10.1007/s00125-012-2639-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Nam JH, Cho E, Kim JS, Park EC, Kim JH. The influences of visceral fat area on the sites of esophageal mucosal breaks in subjects with gastroesophageal reflux diseases. Gastroenterol Res Pract. 2019;2019:9672861. https://doi.org/10.1155/2019/9672861.

    Article  PubMed  PubMed Central  Google Scholar 

  14. World Health Organization [Internet]. Obesity and Overweight; c2021 [cited 2021 June 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

  15. Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021;33:e14058. https://doi.org/10.1111/nmo.14058.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Masuda T, Mittal SK, Kovacs B, Smith M, Walia R, Huang J, et al. Thoracoabdominal pressure gradient and gastroesophageal reflux: insights from lung transplant candidates. Dis Esophagus. 2018;31(10):doy025. https://doi.org/10.1093/dote/doy025.

    Article  Google Scholar 

  17. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  PubMed  Google Scholar 

  18. Derakhshan MH, Robertson EV, Fletcher J, Jones GR, Lee YY, Wirz AA, et al. Mechanism of association between BMI and dysfunction of the gastro-oesophageal barrier in patients with normal endoscopy. Gut. 2012;61:337–43. https://doi.org/10.1136/gutjnl-2011-300633.

    Article  PubMed  Google Scholar 

  19. Mora F, Cassinello N, Mora M, Bosca M, Minguez M, Ortega J. Esophageal abnormalities in morbidly obese adult patients. Surg Obes Relat Dis. 2016;12:622–8. https://doi.org/10.1016/j.soard.2015.08.002.

    Article  PubMed  Google Scholar 

  20. de Mello Del Grande L, Herbella FAM, Katayama RC, Lima WG, Patti MG. Transdiaphragmatic pressure gradient (TPG) has a central role in the pathophysiology of gastroesophageal reflux disease (GERD) in the obese and it correlates with abdominal circumference but not with body mass index (BMI). Obes Surg. 2020;30:1424–8. https://doi.org/10.1007/s11695-019-04345-x.

    Article  Google Scholar 

  21. Prakash Gyawali C, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, et al. Modern diagnosis of GERD The Lyon Consensus. Gut. 2018;67:1351–62. https://doi.org/10.1136/gutjnl-2017-314722. (BMJ Publishing Group).

    Article  PubMed  Google Scholar 

  22. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130:639–49. https://doi.org/10.1053/j.gastro.2005.12.016.

    Article  PubMed  Google Scholar 

  23. Fukazawa K, Furuta K, Adachi K, Shimura S, Kamiyama K, Aimi M, et al. Continuous imaging of esophagogastric junction in patients with reflux esophagitis using 320-row area detector CT: a feasibility study. J Gastroenterol Hepatol. 2013;28:1600–7. https://doi.org/10.1111/jgh.12267.

    Article  PubMed  Google Scholar 

  24. Curcic J, Roy S, Schwizer A, Kaufman E, Forras-Kaufman Z, Menne D, et al. Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. Am J Gastroenterol. 2014;109:658–67. https://doi.org/10.1038/ajg.2014.25.

    Article  PubMed  Google Scholar 

  25. Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7:715–25. https://doi.org/10.1016/S2213-8587(19)30084-1.

    Article  PubMed  Google Scholar 

  26. Nam SY, Choi IJ, Ryu KH, Park BJ, Kim HB, Nam BH. Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women. Gastroenterology. 2010;139:1902-1911.e2. https://doi.org/10.1053/j.gastro.2010.08.019.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kohei Uno.

Ethics declarations

Declarations

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points.

• GERD was common in obesity (34.3%), despite competent EGJ anti-reflux pressure.

• Higher VSR was associated with elevated TAPG, which is a risk factor for GERD.

• VSR may play an important role in pathophysiology of obesity-related GERD.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uno, K., Masuda, T., Watanabe, A. et al. Visceral Obesity is Associated with Thoraco-abdominal Pressure Gradient (TAPG) and Gastroesophageal Reflux Disease. OBES SURG 33, 3871–3878 (2023). https://doi.org/10.1007/s11695-023-06880-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-023-06880-0

Keywords

Navigation