Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery.

Abstract

BACKGROUND:

Obesity is a predisposing factor to gastro-esophageal reflux disease (GERD), but esophageal function remains poorly studied in morbidly obese patients and could be modified by bariatric surgery.

METHODS:

Every morbidly obese patient (BMI > or =40 kg/m2 or > or =35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).

RESULTS:

Before surgery, 100 patients were included (84 F, age 38.4 +/- 10.9 years, BMI 45.1 +/- 6.02 kg/m2), of whom 73% reported GERD symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%; 69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP n = 15/36). The DeMeester score (normal < 14.72) was significantly decreased after RYGBP (24.8 +/- 13.7 before vs. 5.8 +/- 4.9 after; P < 0.001) but tended to increase after AGB (11.5 +/- 5.1 before vs. 51.7 +/- 70.7 after; P = 0.09), with severe dyskinesia in 2 cases.

CONCLUSION:

GERD and LES incompetence are highly prevalent in morbidly obese patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of pH-metric data with occasional severe dyskinesia after AGB.

• Authors: Mohamed Merrouche, Jean-Marc Sabaté, Pauline Jouet, Florence Harnois, Stefano Scaringi, Benoit Coffin, Simon Msika
• Journal: Obesity surgery (Obes Surg) Vol. 17 Issue 7 Pg. 894-900 (Jul 2007) ISSN: 0960-8923 [Print] United States
• PMID: 17894148 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Esophageal Motility Disorders (epidemiology)
• Female
• Follow-Up Studies
• Gastric Bypass (adverse effects)
• Gastroesophageal Reflux (epidemiology)
• Gastroplasty (adverse effects)
• Humans
• Male
• Middle Aged
• Obesity, Morbid (complications, surgery)
• Prospective Studies
• Treatment Outcome