Performance of the Montreal Consensus in the Diagnosis of Gastroesophageal Reflux Disease in Morbidly Obese Patients |
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Authors: | Carlos Augusto Scussel Madalosso Fernando Fornari Sidia M Callegari-Jacques Carlos Antônio Madalosso Richard Ricachenevsky Gurski |
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Institution: | GASTROBESE, Instituto de Gastroenterologia e Colo-Proctologia de Passo Fundo, Rua Uruguai, 1555, 10 andar, 99010102, Passo Fundo, Rio Grande do Sul, Brazil. |
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Abstract: | Background Gastroesophageal reflux disease (GERD) has been increasingly recognized in patients with morbid obesity. A recent global evidence-based
consensus on GERD has been proposed, but its performance in patients with morbid obesity is unknown. The aim of this study
was to assess the performance of the Montreal Consensus in the diagnosis of GERD in morbidly obese patients.
Methods Seventy-five consecutive morbidly obese patients underwent GERD symptoms assessment, upper gastrointestinal endoscopy, and
ambulatory esophageal pH monitoring “off PPI”. The performance of the Montreal Consensus was determined by comparing two diagnostic
algorithms: 1. a gold standard approach in which any GERD symptom and findings from both endoscopy and pH monitoring were
taken into account, and 2. the approach with the Montreal Consensus, in which troublesome GERD symptoms and endoscopic findings
were considered.
Results GERD was found present in 57 patients by applying the gold standard approach. The Montreal Consensus identified 41 of these
patients, whereas the remaining 34 patients were classified as “no GERD”. Of these, 16 (47%) showed reflux esophagitis and/or
abnormal pH-metry. The Montreal Consensus had an accuracy of 78.7%, sensitivity of 72% (95% CI 59–82%), specificity of 100%
(95% CI 82–100%) and negative predictive value of 47% (95% CI 37–57%).
Conclusions In morbidly obese patients, the approach with the Montreal Consensus has high specificity and suboptimal sensitivity in the
diagnosis of GERD. Its intermediate negative predictive value suggests that complementary investigation might be routine in
these patients, particularly in those who do not present with troublesome GERD symptoms.
Madalosso and Fornari contributed equally to the study. |
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Keywords: | Morbid obesity Gastroesophageal reflux disease Endoscopy Esophageal pH monitoring |
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