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Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients.

Abstract

BACKGROUND

Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility disorders in this population.

METHODS

Morbidly obese patients, in whom indication for bariatric surgery was confirmed after complete evaluation, were included consecutively during a 4-year period. The evaluation included history of reflux symptoms, upper GI endoscopy, 24-hour pH monitoring, and stationary esophageal manometry.

RESULTS

345 patients were studied, of whom 35.8% reported reflux symptoms. Endoscopy showed a hiatus hernia in 181 patients (52.6%), and reflux esophagitis in 108 (31.4%). 24-hour pH monitoring revealed an elevated De Meester score in 163 patients (51.7%). Manometry was normal in 247 patients (74.4%), and showed a decreased lower esophageal sphincter pressure in 59 (17.7%). Esophagitis and abnormal pH testing were more common in patients with symptoms or hiatus hernia, and the incidence of esophagitis was higher with abnormal pH testing. Esophagitis was associated with increased weight and abdominal obesity.

CONCLUSIONS

This study confirms the increased prevalence of GERD in the morbidly obese population. Upper GI endoscopy should be performed routinely during evaluation of morbidly obese patients for bariatric surgery. When both conditions coexist, effective treatment is probably best provided by Roux-en-Y gastric bypass, which produces effective weight loss and correction of pathological reflux.

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  • Authors+Show Affiliations

    ,

    Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. michelsuter@span.ch

    , ,

    Source

    Obesity surgery 14:7 2004 Aug pg 959-66

    MeSH

    Adult
    Esophageal Motility Disorders
    Esophagus
    Female
    Gastroesophageal Reflux
    Humans
    Hydrogen-Ion Concentration
    Male
    Manometry
    Middle Aged
    Monitoring, Ambulatory
    Obesity, Morbid

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15329186

    Citation

    Suter, M, et al. "Gastro-esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients." Obesity Surgery, vol. 14, no. 7, 2004, pp. 959-66.
    Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14(7):959-66.
    Suter, M., Dorta, G., Giusti, V., & Calmes, J. M. (2004). Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obesity Surgery, 14(7), pp. 959-66.
    Suter M, et al. Gastro-esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients. Obes Surg. 2004;14(7):959-66. PubMed PMID: 15329186.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. AU - Suter,M, AU - Dorta,G, AU - Giusti,V, AU - Calmes,J M, PY - 2004/8/27/pubmed PY - 2004/12/16/medline PY - 2004/8/27/entrez SP - 959 EP - 66 JF - Obesity surgery JO - Obes Surg VL - 14 IS - 7 N2 - BACKGROUND: Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility disorders in this population. METHODS: Morbidly obese patients, in whom indication for bariatric surgery was confirmed after complete evaluation, were included consecutively during a 4-year period. The evaluation included history of reflux symptoms, upper GI endoscopy, 24-hour pH monitoring, and stationary esophageal manometry. RESULTS: 345 patients were studied, of whom 35.8% reported reflux symptoms. Endoscopy showed a hiatus hernia in 181 patients (52.6%), and reflux esophagitis in 108 (31.4%). 24-hour pH monitoring revealed an elevated De Meester score in 163 patients (51.7%). Manometry was normal in 247 patients (74.4%), and showed a decreased lower esophageal sphincter pressure in 59 (17.7%). Esophagitis and abnormal pH testing were more common in patients with symptoms or hiatus hernia, and the incidence of esophagitis was higher with abnormal pH testing. Esophagitis was associated with increased weight and abdominal obesity. CONCLUSIONS: This study confirms the increased prevalence of GERD in the morbidly obese population. Upper GI endoscopy should be performed routinely during evaluation of morbidly obese patients for bariatric surgery. When both conditions coexist, effective treatment is probably best provided by Roux-en-Y gastric bypass, which produces effective weight loss and correction of pathological reflux. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/15329186/Gastro_esophageal_reflux_and_esophageal_motility_disorders_in_morbidly_obese_patients_ L2 - https://dx.doi.org/10.1381/0960892041719581 DB - PRIME DP - Unbound Medicine ER -