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The Role of the Transdiaphragmatic Pressure Gradient (TGP) in the Pathophysiology of Proximal Reflux

  • SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

An increased transdiaphragmatic pressure gradient (TGP) is a main element for distal gastroesophageal reflux disease (GERD). The role of TGP for proximal reflux is still unclear. This study aims to evaluate the presence, severity, and importance of proximal reflux in relationship to the TGP, comparing healthy volunteers, obese individuals, and patients with chronic obstructive pulmonary disease (COPD).

Methods

We studied 114 individuals comprising 19 healthy lean volunteers, 47 obese individuals (mean body mass index 45 ± 7 kg/m2), and 48 patients with COPD. All patients underwent high-resolution manometry and dual-channel esophageal pH monitoring. Esophageal motility, thoracic pressure (TP), abdominal pressure (AP), TGP, DeMeester score, and % of proximal acid exposure time (pAET) were recorded.

Results

Pathologic distal GERD was found in 0, 44, and 57% of the volunteers, obese, and COPD groups, respectively. pAET was similar among groups, only higher for obese individuals GERD + as compared to obese individuals GERD − and COPD GERD −. pAET did not correlate with any parameter in healthy individuals, but it correlated with AP in the obese, TP in the COPD individuals, and TGP and DeMeester score in both groups. When all individuals were analyzed as a total, pAET correlated with AP, TGP, and DeMeester score. DeMeester score was the only independent variable that correlated with pAET.

Conclusions

Our results show that (a) TGP is an important mechanism associated with distal esophageal acid exposure and this fact is linked with proximal acid exposure and (b) obesity and COPD both seem to be primary causes for GERD but not directly for proximal reflux.

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Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Pedro de Toledo 980 conj. 66, Sao Paulo, SP, 04039002, Brazil

    Leonardo de Mello Del Grande & F. A. M. Herbella

  2. Department of Medicine and Surgery, University of North Carolina, Chapel Hill, NC, USA

    M. G. Patti

Authors
  1. Leonardo de Mello Del Grande
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  2. F. A. M. Herbella
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  3. M. G. Patti
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Contributions

Conception and design, acquisition of data, analysis and interpretation of data, drafting the article: LMDG, FAMH.Acquisition of data, review for intellectual content, final approval of the version to be published: LMDG, FAMH.

Conception and design, review for intellectual content, final approval of the version to be published: LMDG, FAMH, MGP.

Corresponding author

Correspondence to Leonardo de Mello Del Grande.

Ethics declarations

Data is a sub analysis of previous studies3, 6, 7 approved by the local Ethics Committee, and written informed consent was obtained from each subject.

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The authors declare that they have no conflict of interest.

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Plenary session presentation at the SSAT annual meeting, 2020

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Del Grande, L.d.M., Herbella, F.A.M. & Patti, M.G. The Role of the Transdiaphragmatic Pressure Gradient (TGP) in the Pathophysiology of Proximal Reflux. J Gastrointest Surg 25, 351–356 (2021). https://doi.org/10.1007/s11605-020-04849-3

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  • DOI: https://doi.org/10.1007/s11605-020-04849-3

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