Zacchi P, Mearin F, Humbert P, Formiguera X, Malagelada J R
Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona, Spain.
Dig Dis Sci. 1991 Oct;36(10):1473-80. doi: 10.1007/BF01296818.
Chronic (obesity) and acute intraabdominal pressure increases appear to favor gastroesophageal reflux, but the mechanism is not completely understood. We hypothesized that it could be due to an alteration in the resistance gradient between the stomach and the gastroesophageal junction, even increasing intragastric resistance above resistance at the gastroesophageal junction. Hence, we used a pneumatic resistometer to measure gastric and gastroesophageal resistance to flow in 11 lean healthy controls and eight morbidly obese individuals without gastroesophageal reflux disease. Resistance was quantified at rest and during acute intraabdominal pressure increases, both in the recumbent and sitting positions. We found that gastroesophageal junction resistance was higher than gastric resistance in lean as well as in obese subjects (P less than 0.001). In obese individuals both gastric and gastroesophageal junction resistance were increased (P less than 0.001), thus a normal gastric-gastroesophageal junction resistance gradient was maintained. Body position did not modify resistance. Acute increases in intraabdominal pressure decreased the gastric-gastroesophageal junction resistance gradient similarly in obese and lean subjects. We conclude that obesity by itself does not appear to predispose to gastroesophageal reflux, but it creates intraabdominal conditions that may favor reflux whenever the gastroesophageal barrier becomes weakened.
慢性（肥胖）和急性腹内压升高似乎易引发胃食管反流，但其机制尚未完全明确。我们推测这可能是由于胃与胃食管交界处之间阻力梯度的改变，甚至使胃内阻力高于胃食管交界处的阻力。因此，我们使用气动阻力计测量了11名健康瘦人及8名无胃食管反流病的病态肥胖个体的胃和胃食管对液体流动的阻力。在仰卧位和坐位时，分别于静息状态及急性腹内压升高时对阻力进行了量化。我们发现，在瘦人和肥胖受试者中，胃食管交界处的阻力均高于胃阻力（P<0.001）。肥胖个体的胃和胃食管交界处阻力均增加（P<0.001），因此维持了正常的胃 - 胃食管交界处阻力梯度。体位并未改变阻力。急性腹内压升高使肥胖和瘦人受试者的胃 - 胃食管交界处阻力梯度同样降低。我们得出结论，肥胖本身似乎并不会 predispose to 胃食管反流，但它会造成腹内环境，一旦胃食管屏障减弱，就可能有利于反流。 （注：“predispose to”此处翻译为“易引发”，但英文原词更准确意思为“使易患”，此处根据语境灵活翻译）
