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 22 October 2017

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News

Waist belts worsen gastroesophageal reflux

Abdominal compression by waist belt aggravates gastroesophageal reflux, primarily by impairing esophageal clearance, reports June's issue of Gastroenterology.

News image

Central obesity promotes gastroesophageal reflux, which may be related to increased intra-abdominal pressure.

Dr Kenneth McColl and colleagues from the United Kingdom investigated the effect of increasing abdominal pressure by waist belt on reflux in patients with reflux disease.

The researchers performed a prospective study of patients with esophagitis or Barrett’s esophagus.

The team found that the median age was 56 years, and median body mass index was 26.8.

Proton pump inhibitors were stopped at least 7 days before the study and H2 receptor antagonists were stopped for at least 24 hours before.

The belt increased intragastric pressure by a median of 9.0 mmHg after the meal
Gastroenterology

The severity of upper GI symptoms was assessed and measurements of height, weight, and waist and hip circumference taken.

The team performed combined high-resolution pH measurement and manometry in fasted state for 20 minutes, and for 90 minutes following a standardized meal.

The squamocolumnar junction was marked by endoscopically placed radiopaque clips.

The researchers reported that the procedures were performed with and without a waist belt.

Without the belt, the team found that intragastric pressure correlated with waist circumference, with the range in pressure between smallest and largest waist circumference being 15 mmHg.

The research team noted that the belt increased intragastric pressure by a median of 6.9 mmHg during fasting, and by 9.0 mmHg after the meal.

Gastroesophageal acid reflux at each of the pH sensors extending 5.5 cm proximal to the peak lower esophageal sphincter pressure point was increased by approximately 8-fold by the belt.

Following the meal, the team observed that the mean number of reflux events with the belt was 4, vs 2 without.

Transient lower esophageal sphincter relaxations were not increased by the belt, but those associated with reflux were increased.

The researchers noted that the most marked effect of the belt was impaired esophageal clearance of refluxed acid.

The team found that the pattern of impaired clearance was that of rapid re-reflux after peristaltic clearance.

Dr McColl's team concludes, "In a prospective study of patients with esophagitis or Barrett’s esophagus, we found belt compression increased acid reflux following a meal."

"The intragastric pressure rise inducing this effect is well within the range associated with differing waist circumference, and likely to be relevant to the association between obesity and reflux disease."

Gastroenterol 2017: 152(8): 1881–1888
30 May 2017

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