There is a high incidence of inflammation and metaplasia at the gastro-esophageal junction in asymptomatic volunteers.
Additionally, the majority of patients with gastro-esophageal junction adenocarcinomas have no history of reflux symptoms.
Professor McColl and colleagues from the United Kingdom report the effects of waist belt and increased waist circumference on the physiology of the gastro-esophageal junction in asymptomatic volunteers.
The team evaluated 12 subjects with normal, and 12 with increased waist circumference, matched for age and gender.
The subjects were examined fasted and following a meal and with waist belts on and off.
A magnet was clipped to the squamo-columnar junction.
|Waist belt was associated with increased lower oesophageal sphincter pressure|
Combined assembly of magnet-locator probe, 12-channel pH catheter and 36-channel manometer was passed.
The team found that the waist belt and increased waist circumference were each associated with proximal displacement of squamo-columnar junction within the diaphragmatic hiatus, peak lower oesophageal sphincter pressure point and pressure inversion point, and PIP.
The researcchers noted that the magnitude of proximal migration of squamo-columnar junction during transient lower oesophageal sphincter relaxations was reduced by 1.6–2.6 cm with belt on versus off, and in obese versus non-obese, consistent with its resting position being already proximally displaced.
The team found that the waist belt, but not increased waist circumference, was associated with increased lower oesophageal sphincter pressure, and movement of pH transition point closer to squamo-columnar junction.
At 5 cm above upper border lower oesophageal sphincter, the mean % time pH <4 was <4% in all studied groups.
The researchers observed that acid exposure 0.5–1.5 cm above squamo-columnar junction was increased, with versus without, belt and was most marked in obese subjects with belt.
Professor McColl's team comments, "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 gastro-esophageal junction in subjects without a history of reflux symptoms."