Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Gut. 2014 Jul;63(7):1053-60. doi: 10.1136/gutjnl-2013-305803. Epub 2013 Sep 24.
There is a high incidence of inflammation and metaplasia at the gastro-oesophageal junction (GOJ) in asymptomatic volunteers. Additionally, the majority of patients with GOJ adenocarcinomas have no history of reflux symptoms. We report the effects of waist belt and increased waist circumference (WC) on the physiology of the GOJ in asymptomatic volunteers.
12 subjects with normal and 12 with increased WC, matched for age and gender were examined fasted and following a meal and with waist belts on and off. A magnet was clipped to the squamo-columnar junction (SCJ). Combined assembly of magnet-locator probe, 12-channel pH catheter and 36-channel manometer was passed.
The waist belt and increased WC were each associated with proximal displacement of SCJ within the diaphragmatic hiatus (relative to upper border of lower oesophageal sphincter (LOS), peak LOS pressure point and pressure inversion point, and PIP (all p<0.05). The magnitude of proximal migration of SCJ during transient LOS relaxations was reduced by 1.6-2.6 cm with belt on versus off (p=0.01) and in obese versus non-obese (p=0.04), consistent with its resting position being already proximally displaced. The waist belt, but not increased WC, was associated with increased LOS pressure (vs intragastric pressure) and movement of pH transition point closer to SCJ. At 5 cm above upper border LOS, the mean % time pH <4 was <4% in all studied groups. Acid exposure 0.5-1.5 cm above SCJ was increased, with versus without, belt (p=0.02) and was most marked in obese subjects with belt.
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 GOJ in subjects without a history of reflux symptoms.
在无症状志愿者中，胃食管交界处（GOJ）存在高发生率的炎症和化生。此外，大多数 GOJ 腺癌患者没有反流症状史。我们报告了腰带和腰围增加（WC）对无症状志愿者 GOJ 生理学的影响。
12 名正常 WC 组和 12 名 WC 增加组的受试者在空腹和餐后、佩戴和不佩戴腰带时接受检查。将磁铁夹在鳞柱状交界（SCJ）上。组合装配磁定位探头、12 通道 pH 导管和 36 通道测压管通过。
腰带和 WC 增加都与 SCJ 在膈裂孔内的近端移位有关（相对于下食管括约肌（LOS）的上边界、LOS 压力点和压力反转点以及 PIP，所有 p<0.05）。与不戴腰带相比，戴腰带时，在短暂 LOS 松弛期间，SCJ 的近端迁移幅度减少了 1.6-2.6cm（p=0.01），在肥胖与非肥胖者之间（p=0.04），这与 SCJ 的静止位置已经近端移位一致。腰带，但不是 WC 增加，与 LOS 压力（与胃内压力相比）增加和 pH 转换点向 SCJ 移动有关。在 LOS 上边界上方 5cm 处，所有研究组的 pH<4 的时间百分比均<4%。与不戴腰带相比，有腰带时，pH<4 的时间百分比增加（p=0.02），在肥胖且戴腰带的受试者中最为明显。
我们的研究结果表明，在无症状志愿者中，腰带和中心性肥胖导致部分膈疝和短节段酸反流。这为没有反流症状史的 GOJ 炎症和化生发生率高以及肿瘤发生提供了一个合理的解释。
