Changes In Abdominal Pressure Research Articles

The physiological determinants of symptom burden in cirrhosis with ascites.

Paracentesis is commonly used to manage patient discomfort due to ascites. The relationship between ascites pressure, ascites volume, and patient discomfort has not been elucidated. We prospectively enrolled adult patients with non-malignant ascites undergoing outpatient therapeutic paracenteses from 2021 to 2024 at a tertiary care hospital. Patients completed a validated symptom questionnaire (ASI-7, maximum score 35) before, immediately after, and 1week after paracentesis. An open-ended manometer was used to measure ascites pressure at the beginning and end of paracentesis. Mixed effect linear regression was performed to evaluate the relationships between patient characteristics, pressure, volume, and symptoms. One hundred and fifty paracentesis procedures among 48 unique patients with an average Model for End Stage Liver Disease-Sodium 3.0 of 16.7 were included. An average of 6.5L was drained, which reduced abdominal pressure from a mean of 13.7 to 6.0cm H2O (10.1 to 4.4mmHg, p<0.001) and mean symptom score from 22.6 to 6.5 (p<0.001). Regression models identified that symptoms and abdominal pressure linearly correlated above a pressure of 6cm H2O or ASI-7 score of 16 (p<0.01). Taller patients required about 670ml additional drainage per inch above the cohort mean height (5'8″) to achieve the same symptom relief. Pressure measured at the bedside can be used to explore changes in abdominal pressure during paracentesis. Pressure, volume, and patient level factors such as height contribute to patient symptoms but cannot fully explain discomfort associated with ascites and relief after paracentesis.

Navigating the labyrinth of peritoneal and extraperitoneal anatomy: abdominal spread made easy with a case based review.

Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate pathways. The peritoneum is comprised of connected recesses that are potential spaces, normally not imaged except when containing excess fluid or air. Peritoneal recesses are formed by the opposing peritoneal surfaces and subdivided by the attachments of the ligaments and mesenteries to the parietal peritoneum. Disease flows within the recesses by changes in abdominal pressure. This forms a distinct spread pattern. The extraperitoneum is traditionally stratified by the renal fascia into the anterior and posterior pararenal spaces and the perirenal space. The fascia contains and directs spread from the contained organs with the compartments. Each space has a unique spread pattern defined by the containing fascia. The extraperitoneum is connected to the mesenteries and ligaments forming the subperitoneal space. This space interconnects the extraperitoneum with the mesenteries allowing for the normal continuum of blood vessels, lymphatics, and nerves but also forms the pathways for bidirectional spread of disease.

Effects of Longitudinal Changes in Lifestyle-Related Risk Factors on the Incidence of Major Adverse Cardiac and Cerebrovascular Disease in Young Adults.

Metabolic syndrome (MetS) is one focus of healthcare system reform in Japan. We examined the effects of changes in individual risk factors over time on the incidence of major adverse cardio-cerebrovascular events (MACCE) in adults under the age of 50 years. Study participants under the age of 50 with neither hypertension nor hyperglycemia at baseline were analyzed. We used a parametric proportional hazard model to determine the effect of changes in abdominal circumference, blood pressure, serum lipids, and blood glucose on the incidence of MACCE.A total of 6,125 women and 6,403 men were subject to the analyses. The incidence rate of MACCE per 1,000 person-years was 1.17 for women and 2.42 for men. In men under the age of 50, an increase in abdominal circumference was associated with an increase in MACCE incidence (hazard ratio per 1 cm increase: 1.10; 95% confidence interval [CI], 1.04-1.17), whereas no statistically significant association was observed in women. Compared with Visit 1, if the abdominal circumference increased by 4 cm at Visit 3, the hazard ratio for developing MACCE was approximately 1.5 (hazard ratio 1.48; 95% CI, 1.18-1.86). In men under the age of 50, increases in abdominal circumference and systolic blood pressure were associated with an increased risk of developing MACCE, regardless of the degree of obesity at baseline. Therefore, encouraging young adults to improve their health before developing MetS may reduce the risk of MACCE.

Assessment of changes in intra-abdominal pressure and abdominal perfusion pressure in late-term pregnant queens undergoing elective ovariohysterectomy.

Compare changes in intra-abdominal pressure (IAP), abdominal perfusion pressure (APP), hemodynamics, and clinicopathological variables in nonpregnant and late-term pregnant queens undergoing elective ovariohysterectomy (OHE) and evaluate the effect of patient positioning on IAP and APP measurements. 18 late-term pregnant queens and 25 nonpregnant controls. Temperature, heart rate (HR), Doppler blood pressure (DBP), IAP (dorsal and right lateral), PCV, total protein (TP), and lactate were recorded preoperatively, at abdominal wall closure (dorsal IAP only), and postoperatively under general anesthesia. Uterine weight, blood loss, and surgical duration were recorded. Abdominal perfusion pressure was calculated as DBP minus IAP. Pre- and postoperatively, pregnant queens had lower DBP, APP, and PCV compared to controls (P < 0.001). IAP was higher in pregnant queens preoperatively (P < 0.001). Controls had a decrease in HR and increase in IAP, while both groups had a decrease in body temperature, DBP, APP, and lactate over time (P < 0.05). Pregnant queens had a decrease (P = 0.029), and controls had an increase in TP (P = 0.001). Blood loss and surgical time were greater for pregnant queens (P < 0.001). Dorsal IAP and APP were higher and lower than right lateral measurements (P < 0.001), respectively, and correlation was strong. Hemodynamics and APP are impaired in late-term pregnant queens undergoing OHE, and increased monitoring is warranted. Although strongly correlated, feline IAP and APP measurements in dorsal and right lateral recumbency are not interchangeable.

Prediction of blood pressure changes associated with abdominal pressure changes during robotic laparoscopic low abdominal surgery using deep learning.

BackgroundIntraoperative hypertension and blood pressure (BP) fluctuation are known to be associated with negative patient outcomes. During robotic lower abdominal surgery, the patient’s abdominal cavity is filled with CO2, and the patient’s head is steeply positioned toward the floor (Trendelenburg position). Pneumoperitoneum and the Trendelenburg position together with physiological alterations during anesthesia, interfere with predicting BP changes. Recently, deep learning using recurrent neural networks (RNN) was shown to be effective in predicting intraoperative BP. A model for predicting BP rise was designed using RNN under special scenarios during robotic laparoscopic surgery and its accuracy was tested.MethodsDatabases that included adult patients (over 19 years old) undergoing low abdominal da Vinci robotic surgery (ovarian cystectomy, hysterectomy, myomectomy, prostatectomy, and salpingo-oophorectomy) at Soonchunhyang University Bucheon Hospital from October 2018 to March 2021 were used. An RNN-based model was designed using Python3 language with the PyTorch packages. The model was trained to predict whether hypertension (20% increase in the mean BP from baseline) would develop within 10 minutes after pneumoperitoneum.ResultsEight distinct datasets were generated and the predictive power was compared. The macro-average F1 scores of the datasets ranged from 68.18% to 72.33%. It took only 3.472 milliseconds to obtain 39 prediction outputs.ConclusionsA prediction model using the RNN may predict BP rises during robotic laparoscopic surgery.

Intra-abdominal Pressure Monitoring During Negative Pressure Wound Therapy in the Open Abdomen

IntroductionNegative pressure wound therapy (NPWT) is commonly used in open abdomen management, where there may be a simultaneous need for prevention of abdominal hypertension, tamponade of hemorrhage, and continuous fascial tension. The regional pressure dynamics of vacuum dressings are poorly understood. MethodsThree duroc swine underwent mid-line laparotomy and application of vacuum open abdomen dressing, with and without sponge packing. Twenty-five catheters were placed throughout the abdomen to capture and record pressures in each quadrant as the vacuum system was ranged between (−75 mmHg to −200 mmHg pressure). Vital signs and ventilator pressures were measured and recorded concomitantly. ResultsNo variations in ventilatory pressures or vital signs were observed with any setting. NPWT changed pressure in seven of seventy-five catheters (9%), five of which were related to abdominal packing. When data were grouped into abdominal wall, perihepatic, perisplenic, and deep abdominal regions, there was no significant change in abdominal pressure when packing was absent. With packing, only the abdominal wall region showed a pressure change, reaching a maximum of 20% of the set vacuum pressure. ConclusionsNPWT does only little to change the intraabdominal pressure, except in superficial locations in packed abdomens and does not appear to cause hemodynamic changes in a porcine open abdomen model. While NPWT may play an important role in fluid scavenging and fascial tensioning, there are likely to be few benefits or drawbacks specifically related to negative abdominal pressure in the deep abdomen.

Intra abdominal pressure changes in meshplasty and abdominal wall plication techniques in abdominoplasty: a comparative study

Background: Measurement of intra abdominal pressures is used to identify patients at risk of intra-abdominal hypertension and abdominal compartment syndrome after abdominoplasty that may lead to tight closure of the abdomen. This comparative study was aimed at measuring the IAP of patients in groups of meshplasty and abdominal wall plication, intraoperatively and post operatively.Methods: A comparative study was conducted among 34 patients who underwent meshplasty and abdominal wall plication. Each group comprised of 17 patients. All preoperative blood investigations and pre anesthetic evaluations were done. The technique used is decided based on the soft tissue laxity, rectus diastasis and presence of ventral hernias. Intra operatively, IAP was measured soon after the placement of mesh or after Rectus plication and post operatively, IAP was measured within 24 hours. IAP was measured using the intra vesical technique using Foley’s Catheter.Results: Fifty percent of the total patients were in the age group 41-50yrs and 88.2% of the patients were females. No significant variations in IAP, either intraoperative (p=0.051) or post operative (p=0.202), was evidenced in both groups. Post operatively, patient developed minimal complications such as seroma collection, wound infection and respiratory complications, improving on symptomatic treatment and antibiotics.Conclusions: No significant intraoperative or postoperative IAP was found between the two study groups underwent meshplasty and abdominal wall placation techniques.

S582 Abdominal Pressure and Position Changes During Colonoscopy, How Common? And When to Expect?

S582 Abdominal Pressure and Position Changes During Colonoscopy, How Common? And When to Expect?

S0972 Enteroscopy Enabled Using a Novel Dynamic Rigidizing Overtube: An Initial Single Center Experience

INTRODUCTION: Single or double balloon enteroscopy is able to visualize the small bowel well but is not readily available due to the cost and procedural expertise required. A novel dynamic rigidizing overtube is now available to assist with difficult colonoscopy. In its flexible state, the overtube material is soft and pliable, but in its rigid state becomes 15× stiffer when a vacuum is applied. This aids in stability and minimizing loop formation. The aim of this study was to assess feasibility and safety of this novel device for use in performing antegrade and retrograde enteroscopy. METHODS: This was a retrospective study over a 6 month period in which two endoscopists performed retrograde and antegrade enteroscopies using a novel rigidizing overtube. Retrograde enteroscopy was performed via the anus by advancing the overtube to the cecum in its flexible state with the pediatric colonoscope, reducing the scope and overtube construct, and then rigidizing at the cecum. Following rigidization, the scope was pushed through the ileocecal valve and advanced maximally. Antegrade enteroscopy was performed by inserting the dynamic rigidizing overtube with use of the pediatric colonoscope via the mouth, rigidizing in the duodenum or jejunum, and then advancing maximally. RESULTS: A total of 9 retrograde and 3 antegrade enteroscopies were performed. On retrograde enteroscopy, small bowel depth ranged from 15cm to 70cm from the ileocecal valve, with a mean of 48.9cm. There were no complications associated with use of the dynamic rigidizing overtube, both in antegrade and retrograde evaluation. Of note, in one case, initial attempts at retrograde double-balloon enteroscopy failed due to looping and unfavorable angulation of the ileocecal valve. Multiple attempts at intubation including manual abdominal pressure and position changes were unsuccessful. The dynamic rigidizing overtube was then introduced with successful intubation and subsequent exploration of the ileum. Overall, both endoscopists reported significant ease of enteroscopy compared to traditional double-balloon methods, with lower perceived mental and physical demand. CONCLUSION: In this initial study, the novel dynamic rigidizing overtube successfully facilitated both antegrade and retrograde enteroscopy without adverse events. Our results suggest that use of this dynamic rigidizing overtube may have a role in performing enteroscopy in select patients.Figure 1.: Image of the rigidizing overtube. The overtube is placed at the hub of the colonoscope, allowing free tip movement. When the vacuum is applied, the normally flexible overtube becomes fifteen times as rigid, allowing 1 to 1 movement when force is applied to the shaft of the colonoscope.

The Effect of Horse Riding Exercise Equipment Training Velocity on Abdominal Pressure in Healthy Adults Female

Purpose: The purpose of this study is to measure the change in abdominal pressure depending on the speed of the horse riding training exercise equipment. Methods: 27 women with an average age of 21.5 years, height of 164.66 cm, weight 55.07 kg, and body mass index of 21.59 kg/m² were divided into 3 groups, 9 subjects in each group, of low, medium, and high-speed training groups. Each training group was given three times a week during 6 weeks using a horse riding equipment for 20 minutes a day. Abdominal pressure was measured using a stabilizer. Results: Each group trained at low, medium, and high speed showed an increase in abdominal pressure(p<.001). However, comparing the difference in abdominal pressure between groups, the increase in abdominal pressure was higher in the medium and the high speed group than in the low speed group(p<.001). Conclusion: In order to increase the abdominal pressure, it was found that the medium and the high speed horse riding exercise training were more effective than the low speed. This increase in abdominal pressure is thought to affect the increased thickness of the deep abdominal muscles, resulting on trunk stabilization.

The Relation Between the Distance of Rectus Plication and the Intra Abdominal Pressure Changes before and Immediately After Abdominoplasty

Abstract Background tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating and abdominal profile that is smoother and firmer. Diastasis recti means the belly sticks out because the space between left and right belly muscles has widened. The most notable symptom of anterior abdominal wall weakness or diastasis recti is a noticeable protrusion in the stomach. This protrusion is caused by weakness and separation of the muscles in the mid-abdomen. Objective It was to evaluate the relationship between the distance of recto-fascial or recto-fascial diastasis placation and intra-abdominal pressure changes during and immediately after abdominoplasty. Patient and Methodology In this study we demonstrated if there was relation between rectus diastasis width and the increase of intra-abdominal pressure, to evaluate this correlation before and immediately after the plication of anterior rectus sheath in abdominoplasty. Seventy five meeting the inclusion criteria were selected. Results This study enrolled 75 healthy female patients, the study took place at Al-Jamila Hospital, performed in a period of 10 months, starting from March 2017 till December 2017.

Application of language communication and psychological support in urodynamic examination of patients with benign prostatic hyperplasia

Objective To analyze the application value of language communication and psychological support in urodynamic examination of patients with benign prostatic hyperplasia (BPH) . Methods From July 2016 to October 2018, a total of 106 BPH patients who underwent urodynamic examination in the Department of Urology at the First Affiliated Hospital of Kangda College of Nanjing Medical University were enrolled as subjects. They were divided into the observation groups and the control group by random number table method, with 53 cases in each group. The control group was given routine nursing. The observation group was given language communication and psychological support intervention besides routine nursing. The incidence of abnormal abdominal pressure changes, unnatural detrusor contraction, and unnatural external urethral sphincter contraction, examination time, and examination success rate were compared between the two groups. At 20 min before the start of examination (T1) , 10 min after the start of examination (T2) , and 10 min after end of the examination (T3) , changes in hemodynamics indexes [systolic blood pressure (SBP) , diastolic blood pressure (DBP) , heart rate (HR) ]were also analyzed. The pain grading and incidence of complication during examination were compared too. Results The incidence of abnormal abdominal pressure changes, unnatural detrusor contraction, and unnatural external urethral sphincter contraction in the observation group was lower than that in the control group (P<0.05) . The examination time in the observation group was shorter than that in the control group, while the examination success rate was higher than that in the control group (P<0.05) . At T2, SBP, DBP and HR in the observation group were lower than those in the control group. At T3, SBP and DBP in observation group were lower than those in control group (P<0.05) . The pain grade of the observation group was lower than that of the control group (P<0.05) . The incidence of bladder irritation, fever, hematuria and dysuria in the observation group was lower than that in the control group (P<0.05) . Conclusions The application of language communication and psychological support in urodynamic examination for BPH patients can effectively improve examination efficiency, reduce hemodynamic fluctuations and pain, prevent or reduce complications risks so it is worth promoting in clinical practices. Key words: Prostatic hyperplasia; Urodynamic examination; Language communication; Psychological support

AB058. Application of nursing pathway in urodynamic examination

BackgroundExplore the effect of nursing pathway in patients undergoing urodynamic examination.MethodsForty eight patients who underwent urodynamic examination in our department from September 2017 to January 2018 were selected as the control group and 56 patients who underwent urodynamic examination from February 2018 to May 2018 as the observation group. Compare the two groups of patients into the examination room until the start examination, abnormal abdominal pressure changes in the two groups, the situation of the artifacts, the correct rate of doctor’s instructions during the inspection process.ResultsThe time from entering the examination room to start the examination in the observation group was 19.08±10.36 s, which was lower than that in the control group 35.20±6.36 s; the abnormal abdominal pressure in the observation group was 1.28% (1/78), which was significantly lower than that in the control group 10.67% (8/75), and the difference was statistically significant (P<0.05). The pseudo-image of the observation group was significantly lower than that of the control group 33.33% (25/75), the difference was statistically significant (P<0.01). The correct rate of doctor’s instructions in the observation group (92%) was significantly higher than that of the control group (84%).ConclusionsThe application of nursing pathway in patients undergoing urodynamic examination can effectively shorten the time from entering the examination room to the smooth start of the examination, reduce abnormal abdominal pressure changes and the incidence of false images, and improve the correct rate of doctor’s instructions.

Endoscopic Retrograde Cholangiopancreatography (ERCP) in an Intrathoracic Stomach: Novel Use of a Full Spectrum Endoscopy (FUSE) Stiffening Wire

A 96-year-old highly functional woman presented to the ED after a fall at home and was found to be febrile (38.4°C) with right upper quadrant pain. Laboratory evaluation remarkable for a total bilirubin of 2.2 mg/dL, direct bilirubin 1.5 mg/dL, AST 475 U/L, ALT 157 U/L, and alkaline phosphatase 214 U/L. Due to concern for cholangitis she was started on antibiotics and underwent an MRCP which displayed numerous gallbladder stones as well as two stones in the common bile duct measuring up to 1.2 cm. The patient underwent an attempted ERCP, but due to altered anatomy, the duodenoscope could not be passed through the antrum, despite abdominal pressure and position changes (Images A1&2). The upper endoscope was substituted and the pylorus was located and passed into a normal duodenum with difficulty, but the ampulla could not be visualized. Her previous chest imaging was reviewed, which confirmed a complete intrathoracic stomach (Image B). ERCP was reattempted with a different endoscopist the following day, but the duodenoscope was unable to be passed due to excessive looping. The scope was withdrawn, and an Endochoice Drivewire, normally used to stiffen a full spectrum colonoscope (FUSE), was passed through the scope. The duodenoscope was reintroduced, and was then able to be advanced to the ampulla with successful cannulation of the bile duct (Image C). A subsequent cholangiogram revealed a diffusely dilated common bile duct, with a large obstructing stone. A sphincterotomy was performed with successful stone extraction. The patient improved after the procedure, with all laboratories returning to baseline and eventually discharged home. An intrathoracic stomach is a rare condition resulting from a large herniation of a substantial portion of the stomach into the chest through a defect in the diaphragm. It is typically found incidentally on radiographic or endoscopic evaluation. Presentations of this condition form a wide spectrum, as patients may have no clinical symptoms but serious complications such as incarceration of the stomach may also arise in the setting of the herniated stomach leading to volvulus. Endoscopic difficulties have also been reported. In our case, balloon enteroscopy was unlikely to be successful, due to failure to visualize the ampulla with a forward viewing scope. Use of a stiffening Drivewire offers a novel modality and approach to patients with abnormal anatomy that may assist in the management of these challenging cases.Figure

OPTIMIZATION MECHANICAL VENTILATION BY STUDYING THE MECHANICAL PROPERTIES OF THE LUNGS IN NEWBORNS WITH THE SYNDROME OF INTRA-ABDOMINAL HYPERTENSION

Summary. The purpose of the study – optimization of mechanical ventilation by studying the mechanical properties of the lungs in newborns with viscero-abdominal disproportion and the syndrome of intra - abdominal hypertension in the perioperative period. Materials and methods. The study included 57 newborns with gastroschisis of them - 42 infants (73.7%) with omphalocele - 15 (2 (5.3%). All patients underwent intensive therapy, artificial lung ventilation apparatus «BearCub» modes (A / C, SIMV / PSV) with stable hemodynamic monitoring, respiratory mechanics (dynamic komplayns - Cdyn, resistance - Rpk, pressure-volumeloop, flow-volume using graphics monitor). Abdominal pressure measured by Crone . Results. The study found a link between abdominal pressure changes at different stages of research hand changes in respiratory rates in infants. All patients in the preoperative period was marked by the adaptation of newborn respiratory system. On the first day of the first phase correction viscero-abdominal imbalances observed a gradual decrease in dynamic compliance in both groups at 3.4 times, and marked increase in resistance with increase 2.42 times PIP to high numbers of 20-22 cm of water. c., and the maximum change indicators on the graphic display. Return performance mechanical properties of light to a relatively normal range is the end of 72 hours, stretching the skin-muscle flap of the anterior abdominal wall. Conclusion. Increased intra-abdominal pressure to high numbers leads to changes in respiratory mechanics and is very informative criterion for correction of parameters of ventilation. Also marked increase perioperative ICP (over 10-11 mm Hg. C) of the effect on the mechanical properties of the lungs in newborns with viscero-abdominal imbalances.

The “simultaneous contractions” of the human colon are a fast propagating rhythmic neurogenic motor pattern associated internal anal sphincter relaxation and gas expulsion, not an artifact of abdominal pressure changes

The “simultaneous contractions” of the human colon are a fast propagating rhythmic neurogenic motor pattern associated internal anal sphincter relaxation and gas expulsion, not an artifact of abdominal pressure changes

Simple Modification of the Bladder Outlet Obstruction Index for Better Prediction of Endoscopically-Proven Prostatic Obstruction: A Preliminary Study.

PurposeThe bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO.Materials and MethodsWe retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax.ResultsUltimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05).ConclusionsThe change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH.

Mechanism of the increased rib cage expansion produced by the diaphragm with abdominal support.

When the abdomen in quadriplegic subjects is given a passive mechanical support, the expansion of the lower rib cage during inspiration is greater and the inward displacement of the upper rib cage is smaller. These changes have traditionally been attributed to an increase in the appositional force of the diaphragm, but the mechanisms have not been assessed. In this study, the inspiratory intercostal muscles in all interspaces were severed in anesthetized dogs, so that the diaphragm was the only muscle active during inspiration, and the displacements of the ribs 10 and 5 and the changes in pleural and abdominal pressure were measured during unimpeded breathing and during breathing with a plate applied on the ventral abdominal wall. In addition, external forces were applied to the 10th rib pair in the cranial and lateral directions, and the rib trajectories thus obtained were used as the basis for a vector analysis to estimate the relative contributions of the insertional and appositional forces to the rib 10 displacements during breathing. Application of the abdominal plate caused a marked increase in the inspiratory cranial and outward displacement of rib 10 and a decrease in the inspiratory caudal displacement of rib 5. Analysis of the results showed, however, that 1) the insertional and appositional forces contributed nearly equally to the increased inspiratory displacement of rib 10 and 2) the decrease in the expiratory displacement of rib 5 was the result of both the greater displacement of the lower ribs and the decrease in pleural pressure.

Of Changes in Abdominal Pressure During Laparoscopic Cholecystectomy on Respiratory Mechanics, Hemodynamics and Metabolism Effects

Of Changes in Abdominal Pressure During Laparoscopic Cholecystectomy on Respiratory Mechanics, Hemodynamics and Metabolism Effects

Reflux esophagitis is one of highly prevalent comorbidities among patients with chronic obstructive pulmonary disease

See Article on Page 466-473 Patients with chronic obstructive pulmonary disease (COPD) are usually elderly and have a history of tobacco exposure. COPD is therefore a complex disease linked to comorbidities that influence both treatment efficacy and outcomes [1]. These comorbidities not only affect a COPD patient's symptom burden, functional performance, and health status, but also increase his or her risk of hospitalization and mortality [2,3]. Almost all COPD patients have at least one comorbidity, and 53.5% have four or more comorbidities [4]. It has been suggested that a comorbidity should fulfill at least one of the following criteria: 1) mutual impact of one disease on the outcome of the other, 2) the frequency of the disease and its impact on mortality are greater than that of the general population, or 3) the disease is part of a unique COPD phenotype [1]. Researchers using many different methods to identify patients with gastroesophageal reflux disease (GERD), including validated questionnaires, esophageal pH monitors, and medical claims data, have consistently found a higher prevalence of GERD among COPD patients than the general population [1]. When medical claims data are used to identify patients, the prevalence of GERD in Korean COPD patients is 28% [5]. Almost all COPD outcomes are impacted by coexistent GERD, including a decrease in health-related quality of life and an increase in severe symptoms [6]. In a cross-sectional analysis of administrative databases, increased COPD exacerbations were reported in patients with coexistent GERD with an odds ratio of 1.5 (95% confidence interval, 1.5 to 1.6) [5]. Although one small clinical trial showed a 77% reduction in COPD exacerbations with the use of a proton-pump inhibitor [7], specific therapeutic recommendations for GERD in COPD patients are not available. This issue of The Korean Journal of Internal Medicine contains a study of reflux esophagitis (RE) confirmed by esophagogastroduodenoscopy (EGD) in COPD patients. The prevalence of RE in Korean COPD patients is 30%, higher than previously reported in the Korean general population [8]. As the authors discuss, this discrepancy may be due to the presence of RE symptoms, which are not relevant to COPD. However, the exceedingly high prevalence of EGD-confirmed RE in this study's COPD patients should not be ignored. Interestingly, the authors found that inhaled anticholinergics were associated with a decreased risk of RE. This finding is concordant with a cross-sectional analysis of administrative databases [5], which also reported decreased GERD with anticholinergic use. The effect of anticholinergics on RE should be evaluated with well-designed studies, since GERD was more frequently identified in COPD patients with predominantly bronchitis phenotypes (33.6% compared to 27.6% in those without chronic bronchitis) [9], and anticholinergics decrease sputum volume and are frequently used as mucoregulators [10]. Additionally, since 13.3% of COPD patients have a hiatal hernia on chest computed tomography [11], there is renewed attention to the role of mechanical factors such as persistent cough and/or changes in thoracic and abdominal pressures in the development of hiatal hernias and as a potential explanation for the association between COPD and GERD [1]. In summary, RE is common in COPD patients although it is not necessarily associated with significant symptoms. Sophisticated studies of the developmental mechanism and treatment of RE in COPD patients are warranted to provide specific therapeutic recommendations.