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Los function and obesity: the impact of untreated obesity, weight loss, and chronic gastric balloon distension.

Abstract

BACKGROUND/AIMS

In obesity, many gastro-oesophageal reflux promoting factors are present. Weight reduction is advised to symptomatic overweight subjects. The aim of the present study was to investigate the influences of untreated obesity, weight loss, and chronic gastric balloon distension on the lower oesophageal sphincter (LOS) function.

METHODS

Patients entering a randomized, double-blind, sham-controlled study of balloon treatment, consisting of 4 months of either sham balloon or balloon treatment followed by 4 months of balloon treatment. Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks.

RESULTS

Before treatment, LOS dysfunction was present in 7 of 32 patients (21.9%). Increased upright and supine reflux was present in 8 patients (25%). Sham treatment resulted in a weight loss of 9.7% with improved LOS function (a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure) and in a significantly decreased upright reflux (acid reflux time decreasing from 8.0 to 5.5% and number of meal-related and postprandial reflux episodes decreasing from 49 to 32). These improved values deteriorated after 4 months of balloon placement, with significantly increasing total, upright, and supine reflux to 7.5, 7.6, and 6.7% of the time, respectively, with oesophageal lesions after an overall 17.8% weight loss. Four months of balloon treatment induced a similar weight loss (9.9%) with significantly increased supine reflux from 1.6 to 6.7% of the time. After a second 4-month balloon period and an overall 13.8% weight loss, LOS and reflux values returned towards baseline values. A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss.

CONCLUSIONS

Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects. Weight loss ameliorated manometry and pH values, but subsequent balloon positioning tended to counteract these beneficial changes. In patients on balloon treatment from the start, adverse effects seemed to wear off with prolonged treatment.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. e.mathus-vliegen@amc.uva.nl

    ,

    Source

    Digestion 68:2-3 2003 pg 161-8

    MeSH

    Double-Blind Method
    Endoscopy, Gastrointestinal
    Gastric Balloon
    Gastroesophageal Reflux
    Humans
    Hydrogen-Ion Concentration
    Manometry
    Obesity
    Weight Loss

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    14671423

    Citation

    Mathus-Vliegen, E M H., et al. "Los Function and Obesity: the Impact of Untreated Obesity, Weight Loss, and Chronic Gastric Balloon Distension." Digestion, vol. 68, no. 2-3, 2003, pp. 161-8.
    Mathus-Vliegen EM, van Weeren M, van Eerten PV. Los function and obesity: the impact of untreated obesity, weight loss, and chronic gastric balloon distension. Digestion. 2003;68(2-3):161-8.
    Mathus-Vliegen, E. M., van Weeren, M., & van Eerten, P. V. (2003). Los function and obesity: the impact of untreated obesity, weight loss, and chronic gastric balloon distension. Digestion, 68(2-3), pp. 161-8.
    Mathus-Vliegen EM, van Weeren M, van Eerten PV. Los Function and Obesity: the Impact of Untreated Obesity, Weight Loss, and Chronic Gastric Balloon Distension. Digestion. 2003;68(2-3):161-8. PubMed PMID: 14671423.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Los function and obesity: the impact of untreated obesity, weight loss, and chronic gastric balloon distension. AU - Mathus-Vliegen,E M H, AU - van Weeren,M, AU - van Eerten,P V, Y1 - 2003/12/10/ PY - 2003/05/12/received PY - 2003/10/06/accepted PY - 2003/12/13/pubmed PY - 2004/5/20/medline PY - 2003/12/13/entrez SP - 161 EP - 8 JF - Digestion JO - Digestion VL - 68 IS - 2-3 N2 - BACKGROUND/AIMS: In obesity, many gastro-oesophageal reflux promoting factors are present. Weight reduction is advised to symptomatic overweight subjects. The aim of the present study was to investigate the influences of untreated obesity, weight loss, and chronic gastric balloon distension on the lower oesophageal sphincter (LOS) function. METHODS: Patients entering a randomized, double-blind, sham-controlled study of balloon treatment, consisting of 4 months of either sham balloon or balloon treatment followed by 4 months of balloon treatment. Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks. RESULTS: Before treatment, LOS dysfunction was present in 7 of 32 patients (21.9%). Increased upright and supine reflux was present in 8 patients (25%). Sham treatment resulted in a weight loss of 9.7% with improved LOS function (a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure) and in a significantly decreased upright reflux (acid reflux time decreasing from 8.0 to 5.5% and number of meal-related and postprandial reflux episodes decreasing from 49 to 32). These improved values deteriorated after 4 months of balloon placement, with significantly increasing total, upright, and supine reflux to 7.5, 7.6, and 6.7% of the time, respectively, with oesophageal lesions after an overall 17.8% weight loss. Four months of balloon treatment induced a similar weight loss (9.9%) with significantly increased supine reflux from 1.6 to 6.7% of the time. After a second 4-month balloon period and an overall 13.8% weight loss, LOS and reflux values returned towards baseline values. A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss. CONCLUSIONS: Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects. Weight loss ameliorated manometry and pH values, but subsequent balloon positioning tended to counteract these beneficial changes. In patients on balloon treatment from the start, adverse effects seemed to wear off with prolonged treatment. SN - 0012-2823 UR - https://www.unboundmedicine.com/medline/citation/14671423/Los_function_and_obesity:_the_impact_of_untreated_obesity_weight_loss_and_chronic_gastric_balloon_distension_ L2 - https://www.karger.com?DOI=10.1159/000075525 DB - PRIME DP - Unbound Medicine ER -