77 Diseases of the Esophagus (2003) 16, 77–82 © 2003 ISDE/Blackwell Science Asia Blackwell Publishing Ltd. Original article Reduction of abdominal pressure in patients with ascites reduces gastroesophageal reflux T. Navarro-Rodriguez, 1 C. L. Hashimoto, 1 F. J. Carrilho, 1 E. Strauss, 2 A. A. Laudanna, 1 J. P. P. Moraes-Filho 1 1 Department of Gastroenterology, Faculty of Medicine, University of São Paulo, Brazil and 2 Gastroenterology Service, Heliopolis Hospital, São Paulo, Brazil. (This study was supported by FAPESP – State of Sao Paulo Foundation for Supporting Research.) SUMMARY. The effect of the reduction of intra-abdominal pressure on the lower esophageal sphincter pres- sure (LESP) and the 24-hour pH monitoring were studied in 16 patients with ascites before and after para- centesis. LESP did not change (P > 0.05) with the reduction of intra-abdominal pressure (before paracentesis: 17.48 mmHg and postparacentesis: 18.67 mmHg). The results were divided into two groups according to the achieved reduction in intra-abdominal pressure group A were those in who the reduction was greater than 70% and B consisted of those a reduction of less than 70%. LESP did not change even when results for each group were considered separately (P > 0.05): group A (before: 15.60 mmHg; after: 18.09 mmHg); group B (before: 23.09 mmHg; after: 20.40 mmHg). However the 24-h pH monitoring showed pathological reflux in patients with ascites that was reduced with the paracentesis (P < 0.05; total number of reflux episodes before para- centesis was 520.26, and after, 136.26). All pH-monitoring parameters were statistically different (P < 0.05) before and after the reduction of intra-abdominal pressure for group A but not for group B. LESP does not change significantly (P > 0.05) when the intra-abdominal pressure is significantly reduced (P < 0.05). Patients with ascites showed gastroesophageal reflux. Intra-abdominal pressure reduction greater than 70% lead to a significant reduction in gastroesophageal reflux. KEY WORDS: 24-h pH-metry, ascites, esophageal manometry, gastroesophageal reflux. INTRODUCTION Gastroesophageal reflux disease (GERD) is a major medical and social disorder with high incidence and morbidity, leading to varying symptom severity, which may be present for a prolonged duration and impair the patients’ quality of life. 1 Different aspects of GERD have been studied such as: gastric secretory profile, 2 lower esophageal sphincter pressure levels, 3,4 esophageal emptying by esophageal scintigraphy, 5 and quantitative and qualitative characteristics of pathological reflux, 6 but the role of intra-abdominal pressure (IAP) is still unclear. In fact it has not yet been definitely established if IAP promotes alterations in the lower esophageal sphincter (LES) pressure, or whether IAP has an affect on gastroesophageal reflux (GER). In 1970, Cohen and Harris studied the relation- ship between IAP and lower esophageal sphincter strength, 7 and concluded that increases in LES were directly associated with an increase in IAP. These authors, however, did not study the major effect of sphincter pressure decrease that is GER. Further, as a result of the technology available at the time, increased IAP could not be correlated with the LES pressure. In pregnancy, a condition in which there is a physiological increase of IAP, the LES of patients with heartburn was evaluated by manometric studies, showing a significant pressure decrease when compared to the postpartum evaluation. 8,9 It was concluded that progesterone, administered alone or in combination with estrogen may play an important role in the mechanism of LES pressure decrease. However, quantification of GER, if pres- ent at all, was not established. 8,9 Address correspondence to: Professor Joaquim Prado P Moraes- Filho, MD, Faculty of Medicine, University Sao Paulo, Rua Itapaiuna 1165 c 28, São Paulo, 05707–001 – Brazil. Tel. (+55) 11 9981 7044. Fax. (+55) 11 3083 2016. E-mail: joaquim.prado@uol.com.br. Downloaded from https://academic.oup.com/dote/article/16/2/77/2420024 by guest on 04 February 2023