Document Detail

Central obesity in asymptomatic volunteers is associated with increased intrasphincteric acid reflux and lengthening of the cardiac mucosa.
MedLine Citation:
PMID:  23796455     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: In the West, a substantial proportion of subjects with adenocarcinoma of the gastric cardia and gastroesophageal junction have no history of reflux. We studied the gastroesophageal junction in asymptomatic volunteers with normal and large waist circumferences (WCs) to determine if central obesity is associated with abnormalities that might predispose individuals to adenocarcinoma.
METHODS: We performed a study of 24 healthy, Helicobacter pylori-negative volunteers with a small WC and 27 with a large WC. Abdominal fat was quantified by magnetic resonance imaging. Jumbo biopsy specimens were taken across the squamocolumnar junction (SCJ). High-resolution pH-metry (12 sensors) and manometry (36 sensors) were performed in upright and supine subjects before and after a meal; the SCJ was visualized fluoroscopically.
RESULTS: The cardiac mucosa was significantly longer in the large WC group (2.5 vs 1.75 mm; P = .008); its length correlated with intra-abdominal (R = 0.35; P = .045) and total abdominal (R = 0.37; P = .034) fat. The SCJ was closer to the upper border of the lower esophageal sphincter (LES) in subjects with a large WC (2.77 vs 3.54 cm; P = .02). There was no evidence of excessive reflux 5 cm above the LES in either group. Gastric acidity extended more proximally within the LES in the large WC group, compared with the upper border (2.65 vs 4.1 cm; P = .027) and peak LES pressure (0.1 cm proximal vs 2.1 cm distal; P = .007). The large WC group had shortening of the LES, attributable to loss of the distal component (total LES length, 3 vs 4.5 cm; P = .043).
CONCLUSIONS: Central obesity is associated with intrasphincteric extension of gastric acid and cardiac mucosal lengthening. The latter might arise through metaplasia of the most distal esophageal squamous epithelium and this process might predispose individuals to adenocarcinoma.
Elaine V Robertson; Mohammad H Derakhshan; Angela A Wirz; Yeong Yeh Lee; John Paul Seenan; Stuart A Ballantyne; Scott L Hanvey; Andrew W Kelman; James J Going; Kenneth E L McColl
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-06-22
Journal Detail:
Title:  Gastroenterology     Volume:  145     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-23     Completed Date:  2013-12-09     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  730-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cardia / pathology*
Esophageal Sphincter, Lower / pathology
Gastric Acidity Determination
Gastroesophageal Reflux / etiology*
Middle Aged
Mucous Membrane / pathology
Obesity / complications*,  pathology
Waist Circumference*
Grant Support
CZB/4/709//Chief Scientist Office
Comment In:
Gastroenterology. 2013 Oct;145(4):708-11   [PMID:  23978439 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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