Thoraco-Abdominal Pressure Gradients During the Phases of Respiration Contribute to Gastroesophageal Reflux Disease

Abstract

The gastroesophageal barrier function of the LES can be overcome during times when the inspiratory thoraco-abdominal pressure gradient is increased, leading to reflux of gastric juice into the esophagus. This implies that exaggerated ventilatory effort, as occurs with exercise or in respiratory disease, can result in gastroesophageal reflux.

Determinants of Gastroesophageal Reflux Disease, Including Hookah Smoking and Opium Use– A Cross-Sectional Analysis of 50,000 Individuals

“…For example, mean puff volume in hookah smoking is generally over 500 mL [33], [43], [44], which is several times bigger than usual puff volumes in cigarette smoking (40–70 mL) [43]. Therefore, hookah smoking can induce strong negative intra-thoracic pressure and increase thoraco-abdominal pressure gradient, which may increase gastroesophageal reflux [45].…”

“…Increased intra-abdominal pressure or thoraco-abdominal pressure gradients may be among the main possible explanations for the association of GERD with BMI and, in particular, central obesity [45], [75]. However, there seems to be other mechanisms contributing to this association, including reduced lower esophageal sphincter pressure in obese individuals [75], [76].…”

Idiopathic pulmonary fibrosis is associated with increased impedance measures of reflux compared to non‐fibrotic disease among pre‐lung transplant patients

“…As clinical symptoms have been shown to be unreliable in evaluating GER in IPF patients, GER might contribute to the natural history of IPF through silent microaspiration even in the absence of typical esophageal symptoms . On the other hand, pulmonary fibrosis and worsening lung function may lead to increased negative intrathoracic pressure and greater transdiaphragmatic pressure gradient during respiration, thereby predisposing to gastric reflux in this patient population …”

“…14 On the other hand, pulmonary fibrosis and worsening lung function may lead to increased negative intrathoracic pressure and greater transdiaphragmatic pressure gradient during respiration, thereby predisposing to gastric reflux in this patient population. 1,15 While proton-pump inhibitor (PPI) therapy is widely used for symptomatic GER, the effect of acid suppression on pulmonary outcomes in IPF patients has not been definitively established, although a few studies have shown some benefits. 13,16 Studies evaluating broncho-alveolar lavage of patients with IPF demonstrated an increase in both pepsin and bile acids, 14,17,18 suggesting that non-acid reflux may also play a role in the pathogenesis or progression of IPF.…”

Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study

“…Together with the restricted expiration in asthmatics, there is an increase in abdominal wall muscle contraction to compensate for breathing, lung hyperinflation with lowering of the diaphragm, together with fluctuations in intra-thoracic and intra-abdominal pressures. All the aforementioned might hypothetically explain the significantly higher prevalence of dysphonia, phonatory effort and vocal fatigue in the asthmatic group [24].…”