Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery |
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Authors: | Mohamed Merrouche Jean-Marc Sabaté Pauline Jouet Florence Harnois Stefano Scaringi Benoit Coffin Simon Msika |
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Affiliation: | 1. AP-HP, H?pital Louis Mourier, University Paris VII, Service d’Hépato-Gastroentérologie, Colombes, France 2. AP-HP, H?pital Louis Mourier, University Paris VII, Service de Chirurgie digestive, Colombes, France 3. Service de Chirurgie Digestive, H?pital Louis Mourier, Assistance Publique-H?pitaux de Paris (AP-HP) Université Paris VII, 178 rue des Renouillers, 92701, Colombes CEDEX, France
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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 ≥40 kg/m2 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. |
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Keywords: | Morbid obesity bariatric surgery esophagus manometry 24-hour pH monitoring GERD |
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