Lumbar kyphosis increases the risk of gastro-oesophageal reflux disease

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A study published ahead of print in the European Spine Journal suggests that lumbar kyphosis, poor sagittal balance, and decreased back muscle strength are important risk factors for gastro-oesophageal disease (GORD; GERD in USA).

According to Shiro Imagama, Department of Orthopaedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan, and co-authors, kyphosis is linked to GORD but the relationship between the two conditions is unclear. They report: “GORD is of concern in elderly patients because many of these patients have kyphosis and take oral medication [a risk factor for GORD]. Thus, GORD in elderly patients with spinal deformity may be a particularly concern in spine surgery.”


The 245 participants (100 men and 145 females) in their study were healthy volunteers who had an average age of 66.7 years. Imagama
et al assessed them using lumbar lateral standing radiographs, SpinalMouse (Idiag), which is an electronic computer-aided device that non-invasively measures sagittal spinal range of motion (ROM) and intersegmental angles, and the Frequency Scale for Symptoms of GORD (FSSG) questionnaire to detect the presence of GORD. They also reviewed body mass index (BMI), the presence of osteoporosis, back muscle strength, number of oral drugs taken per day, non-steroidal anti-inflammatory drugs (NSAIDs) intake, intake of bisphosphonates, and smoking and alcohol intake.


Imagama et al found that the lumbar lordosis angle, back muscle strength, and sacral inclination angle were significantly smaller in participants with GORD (60 overall; score of ≥8), but also found that the thoracic/lumbar angle (T/L) ratio and the number of drugs taken per day were significantly larger in this group. They did not find any differences between participants with GORD and those without GORD in terms of BMI, osteoporosis, thoracic kyphosis angle, spinal ROM, intake of oral NSAIDs, oral bisphosphonates, and smoking and alcohol history. Using a multivariate analysis, Imagama et al found that reduced lumbar lordosis was the most significant risk factor for development of GORD symptoms. They wrote: “Every additional one degree of lumbar kyphosis increased the chance of having GORD by approximately 1.1, indicating a 2.59 times higher risk of GORD development with a decrease of lumbar lordosis of 10 degrees.”


They added that their study is the first to show a relationship between reduced back muscle strength and the incidence of GORD, but explained that a previous study of theirs did show that improved back muscle strength was an “important factor for maintaining the lumbar lordosis angle and spinal sagittal balance.” They said: “Therefore, it is likely that decreased back muscle strength will lead to a lumbar kyphosis, a bent-forward posture and an increase in intra-abdominal pressure, resulting in GORD.”


In their conclusion, Imagama et al wrote that the value of their study was that it was the first examination of the association between GORD and multiple clinical factors in healthy participants (previous studies have not examined all of the potential factors). They added: “These findings suggest GORD may be prevented in maintaining spinal balance and back muscle strength in elderly patients. This indicates that orthopaedic surgeons should pay careful attention to GORD in elderly patients with spinal deformity.” 

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