Transdiaphragmatic Pressure Gradient (TPG) Has a Central Role in the Pathophysiology of Gastroesophageal Reflux Disease (GERD) in the Obese and it Correlates with Abdominal Circumference but Not with Body Mass Index (BMI)

The Impact of Bariatric Procedures on Esophageal Motility

“…3,5 GERD may occur nevertheless if the transdiaphragmatic pressure gradient is higher than the resting pressure of the LES. 6 This is supported by the findings that all obese patients with an abdominal circumference over 150 cm were found to have GERD. 6 Transient relaxations of the LES are, however, more common in the obese and may also contribute to GERD in the setting of normal LES basal pressure.…”

“…6 This is supported by the findings that all obese patients with an abdominal circumference over 150 cm were found to have GERD. 6 Transient relaxations of the LES are, however, more common in the obese and may also contribute to GERD in the setting of normal LES basal pressure. 7 Disjunction between the LES and diaphragm pressures (manometric hiatal hernia) is also more common in the obese even when a hiatal hernia is not present as measured by other methods.…”

Rethinking gastroesophageal reflux disorder

“…Increased intra‐abdominal pressure led to increased transdiaphragmatic pressure gradient (TPG) and slowed the esophageal transit time, leading to the development of reflux 29,30 . This correlates specifically with central obesity rather than increasing BMI alone 31 . There is an increased prevalence of hiatus hernia (HH) in the obese population, occurring in nearly 40% of morbidly obese patients 32,33 .…”

“…29,30 This correlates specifically with central obesity rather than increasing BMI alone. 31 There is an increased prevalence of hiatus hernia (HH) in the obese population, occurring in nearly 40% of morbidly obese patients. 32,33 The anatomical structure and barrier function of the LES is thereby impaired, as described earlier.…”

The Effect of Bariatric Surgery and Endoscopic Procedures on Gastroesophageal Reflux Disease

“…A recent study of obese individuals (BMI > 35 kg/m 2 ) corroborated findings by both Mercer and Pandolfino by evaluating the relationship between the transdiaphragmatic pressure gradient and GERD. 20 The presence of GERD and symptom severity correlated with a high transdiaphragmatic pressure gradient due to increasing abdominal pressures. Interestingly, while elevated abdominal pressure was associated with abdominal circumference, there was no correlation with BMI.…”