Effect of obesity on esophageal transit

doi:10.1016/S0002-9610(85)80029-5

The American Journal of Surgery

Volume 149, Issue 1, January 1985, Pages 177-181

https://doi.org/10.1016/S0002-9610(85)80029-5 Get rights and content

Summary

Esophageal transit time as measured by radionuclide scintigraphy using a swallowed technetium sulfur colloid bolus was measured in obese patients with gastroesophageal reflux, lean patients with reflux, and lean volunteers without reflux. The esophageal transit time was significantly prolonged in the obese group compared with both lean groups (p <0.001). Esophageal manometric measurement also confirmed that obese patients have an elevated gastroesophageal pressure gradient, presumably caused by increased intraabdominal pressure resulting from the mechanical burden of excess fat. The esophageal transit time is significantly related to the gastroesophageal pressure gradient. This finding, coupled with those in previous manometric investigations showing that esophageal muscle has a decreased maximum velocity with increasing afterload, explains in part why obese patients have delayed esophageal transit time. Therapy for reflux in obese patients should be aimed at improving esophageal transit.

References (21)

AlexanderJK
Chronic heart disease due to obesity
J Chronic Dis
(1965)
RabkinSW et al.
Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study
Am J Cardiol
(1977)
BeauchampG
Gastroesophageal reflux and obesity
Surg Clin North Am
(1983)
RussellCOH et al.
Radionuclide transit: a sensitive screening test for esophageal dysfunction
Gastroenterology
(1981)
KeysA et al.
Indices of relative weight and obesity
J Chron Dis
(1972)
TolinRD et al.
Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit)
Gastroenterology
(1979)
WrightRA et al.
Gastric emptying and obesity
Gastroenterology
(1983)
ChiangBN et al.
Overweight and hypertension
Circulation
(1969)
HeydenS et al.
Weight and weight history in relation to cerebrovascular and ischemic heart disease
Arch Intern Med
(1971)
MannGV
The influence of obesity on health
N Engl J Med
(1974)

There are more references available in the full text version of this article.

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Obesity increases the prevalence of esophageal motility disorders. For example, esophageal transit time was prolonged significantly in subjects with obesity compared with lean subjects,1 possibly because of increased gastric and gastroesophageal junction resistance.2 The typical abnormalities of esophageal motility are nonspecific abnormalities of esophageal peristalsis and, rarely, lower esophageal sphincter (LES) dysfunction, including isolated hypertensive or hypotensive LES pressures.
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In a morbidly obese population, heartburn (50.9%) and regurgitation (28.6%) were the most prevalent symptoms of GERD. Endoscopy registered hiatus hernia (12.5%) and reflux esophagitis (17.3%). Manometry was often abnormal (33.4%), with a hypotensive lower esophageal sphincter as the most common finding. Esophageal pH-metry was abnormal in 54.2% of the cases. Finally, 9.1% of the patients presented with abnormal isotopic esophageal emptying. A correlation between the degree of obesity and the severity of symptoms/objective tests for esophageal abnormalities could not be found.
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Citation Excerpt :
In this small case series, Roux-en-Y gastrojejunostomy resulted in complete or partial regression of BE in four of five patients with improvement in reflux symptoms in all. Obesity may contribute to gastroesophageal reflux through several anatomic and physiologic mechanisms (eg, increased intra-abdominal pressure and development of hiatus hernia,44 increased intragastric pressure and gastroesophageal sphincter gradient,45 slower esophageal transit times,46 and increased transient relaxations of the lower esophageal sphincter47). Few studies have distinguished between overall obesity and abdominal obesity, but one recent study showed a similar, albeit weak, positive correlation between the BMI and waist circumference and intragastric pressure.48

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^*: Presented at the 25th Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 22–23, 1984.

¹: Dr. Mercer is Howard Wright Research Fellow in Diseases of the Esophagus and Cancer.

View full text

Effect of obesity on esophageal transit*

Summary

J Chronic Dis

Am J Cardiol

Surg Clin North Am

Gastroenterology

J Chron Dis

Gastroenterology

Gastroenterology

Overweight and hypertension

Circulation

Weight and weight history in relation to cerebrovascular and ischemic heart disease

Arch Intern Med

The influence of obesity on health

N Engl J Med