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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)

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Abstract

Introduction

Pathophysiology of gastroesophageal reflux disease (GERD) is multifactorial. An increased transdiaphragmatic pressure gradient (TPG) may be a main element for GERD in the obese patient. This study aims to evaluate the role of TPG in the physiopathology of GERD in obese individuals.

Methods

We studied 47 unselected consecutive candidates for bariatric operations (body mass index (BMI) > 35). All patients underwent high-resolution manometry and esophageal pH monitoring. Individuals were grouped as GERD + or GERD − based on DeMeester score. Abdominal pressure (AP) and thoracic pressure (TP), transdiaphragmatic pressure gradient (AP-TP), and lower esophageal sphincter (LES) retention pressure (LES basal pressure-TPG) were determined. Manometric variables were compared with a group of 20 lean healthy individuals (BMI < 25).

Results

There were 27 (57%) GERD + patients and 20 (43%) GERD − patients. TPG, waist circumference, LES retention pressure, and AP were higher in GERD + group as compared with GERD − individuals. GERD − group had manometric parameters similar to controls except for AP. GERD + patients had higher AP and TPG and lower LES retention pressure compared with controls. TPG and LES retention pressure correlated with waist circumference and DeMeester score. BMI correlated with AP but not with waist circumference or DeMeester score.

Conclusion

In the obese, GERD presence and severity were associated to a high TPG due to increase AP that correlates with waist circumference.

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Abbreviations

GERD:

Gastroesophageal reflux disease

TPG:

Transdiaphragmatic gradient pressure

LES:

Lower esophageal sphincter

LESRP:

LES retention pressure

GEJ:

Gastroesophageal junction

DCI:

Distal contractile integral

R:

Pearson correlation coefficient

LES:

Lower esophageal sphincter

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Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil

    Leonardo de Mello Del Grande, Fernando Augusto Mardiros Herbella, Rafael Caue Katayama & William Guidini Lima

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

    Marco G Patti

Authors
  1. Leonardo de Mello Del Grande
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  2. Fernando Augusto Mardiros Herbella
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  3. Rafael Caue Katayama
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  4. William Guidini Lima
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  5. Marco 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: RCK, WGL

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

Corresponding author

Correspondence to Fernando Augusto Mardiros Herbella.

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Quickshot presentation at the 60th SSAT Annual meeting, San Diego, US, May, 2019

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de Mello Del Grande, L., Herbella, F.A.M., Katayama, R.C. et al. 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 30, 1424–1428 (2020). https://doi.org/10.1007/s11695-019-04345-x

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  • DOI: https://doi.org/10.1007/s11695-019-04345-x

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