Is ineffective oesophageal motility associated with reflux oesophagitis?

OBJECTIVE: To evaluate the association between ineffective oesophageal motility and reflux oesophagitis controlling for hiatal hernia, hypotensive lower oesophageal sphincter and male sex in patients with gastro-oesophageal reflux disease. METHODS: A total of 387 patients with reflux disease (mean age, 46 years, 42% men) were consecutively selected from a database. All patients underwent upper endoscopy, oesophageal manometry and 24 h oesophageal pH-metry in accordance with a standardized protocol. Reflux disease was confirmed either by endoscopy (oesophagitis grade I-IV according to Savary-Miller) or by pH-metry (increased acid exposure). Hiatal hernia was diagnosed endoscopically, whereas ineffective oesophageal motility and hypotensive lower oesophageal sphincter were characterized during manometry testing. The association between ineffective oesophageal motility and reflux oesophagitis was assessed by logistic regression analysis. RESULTS: A total of 166 patients with oesophagitis (mean age 45 years, 49% men) and 221 without oesophagitis (mean age 46 years, 37% men) were present. Prevalences of ineffective oesophageal motility, hiatal hernia, hypotensive lower oesophageal sphincter and male sex were significantly higher in patients with oesophagitis compared with those without oesophagitis (P<0.05). Ineffective oesophageal motility was independently associated with oesophagitis after multivariate logistic regression analysis (odds ratio=1.68; 95% confidence interval=1.04-2.70). CONCLUSION: Ineffective oesophageal motility is associated with reflux oesophagitis, independently of hiatal hernia, hypotensive lower oesophageal sphincter and male sex.

Prenatal weight gain following smoking cessation.

OBJECTIVE: To evaluate the association of changes in smoking habit with maternal weight gain. STUDY DESIGN: We questioned 4000 pregnant women > or =20 years about previous and current smoking habits during a second trimester visit to general prenatal clinics in 6 Brazilian cities, from 1991 to 1995, and followed their weight, through chart review, to term. RESULTS: Of women who reported stopping smoking (915, 23% of the total), 240 (26.2%) stopped during pregnancy. The median number of cigarettes smoked/day among those who reported continued smoking (717, 18%) decreased from 10 to 5 with pregnancy. In linear regression models adjusting for age, educational attainment, ethnicity, prepregnancy body mass index, parity and clinical center, ex-smokers gained 1.03 kg (95%CI 0.59-1.46) more than those reporting never smoking, this difference being greater: 1.54 kg (95%CI 0.78-2.30) in those who reported quitting while pregnant. The size of weight gain in both continuing smokers and ex-smokers was proportional to the reduction in daily number of cigarettes smoked during pregnancy, being 0.38 kg (95%CI 0.07-0.68) greater for each 10 cigarettes reduced (p=0.007). CONCLUSION: Decreasing the quantity of cigarettes smoked in pregnancy, although important for maternal and child health, is associated with maternal weight gain.