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Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery.

Abstract

BACKGROUND

Controversial findings about the relationships between obesity and gastro-esophageal reflux have been reported, as well as about the effects of weight loss and bariatric surgery on reflux. The aims of this study were to evaluate esophageal motility and gastro-esophageal acid circadian patterns in obese patients and to test the effects of vertical banded gastroplasty (VBG) on these parameters.

METHODS

14 obese subjects (BMI 36-53 kg/m2), 4 men, 10 women, 27-61 years old, admitted for elective bariatric surgery, underwent clinical evaluation, upper endoscopy, esophageal manometry and gastroesophageal pH monitoring. Evaluations were repeated 6 to 12 months after gastric surgery that consisted of a VBG (7 patients), accompanied in the other 7 patients with an anti-reflux procedure (fundoplication). Manometric and pH-metric findings in the obese patients were compared with a normal-weight control group before and after the two different surgical treatments.

RESULTS

Gastro-esophageal reflux was significantly more frequent in obese (57.1%) than in control group (7.1%). Esophageal motility in obese subjects was not different from controls. After VBG alone, we found a reduction in basal lower esophageal sphincter (LES) pressure and an increase of acid reflux. When VBG was accompanied by fundoplication, basal LES pressure increased and acid reflux frequency decreased.

CONCLUSIONS

Obesity is associated with gastroesophageal reflux. VBG reduced weight, but not gastro-esophageal acid reflux. Therefore, in our population, this operation cannot be considered as an antireflux procedure.

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  • Authors+Show Affiliations

    ,

    Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy. vicenzo.difranesco@univr.it

    , , , , , , , , ,

    Source

    Obesity surgery 14:8 2004 Sep pg 1095-102

    MeSH

    Adult
    Circadian Rhythm
    Diagnostic Techniques, Digestive System
    Female
    Gastroesophageal Reflux
    Gastrointestinal Motility
    Gastroplasty
    Humans
    Male
    Middle Aged
    Obesity, Morbid
    Prospective Studies
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article

    Language

    eng

    PubMed ID

    15479599

    Citation

    Di Francesco, Vincenzo, et al. "Obesity and Gastro-esophageal Acid Reflux: Physiopathological Mechanisms and Role of Gastric Bariatric Surgery." Obesity Surgery, vol. 14, no. 8, 2004, pp. 1095-102.
    Di Francesco V, Baggio E, Mastromauro M, et al. Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg. 2004;14(8):1095-102.
    Di Francesco, V., Baggio, E., Mastromauro, M., Zoico, E., Stefenelli, N., Zamboni, M., ... Cavallini, G. (2004). Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obesity Surgery, 14(8), pp. 1095-102.
    Di Francesco V, et al. Obesity and Gastro-esophageal Acid Reflux: Physiopathological Mechanisms and Role of Gastric Bariatric Surgery. Obes Surg. 2004;14(8):1095-102. PubMed PMID: 15479599.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. AU - Di Francesco,Vincenzo, AU - Baggio,Elda, AU - Mastromauro,Marina, AU - Zoico,Elena, AU - Stefenelli,Norma, AU - Zamboni,Mauro, AU - Panourgia,Maria Panagiota, AU - Frulloni,Luca, AU - Bovo,Paolo, AU - Bosello,Ottavio, AU - Cavallini,Giorgio, PY - 2004/10/14/pubmed PY - 2005/1/12/medline PY - 2004/10/14/entrez SP - 1095 EP - 102 JF - Obesity surgery JO - Obes Surg VL - 14 IS - 8 N2 - BACKGROUND: Controversial findings about the relationships between obesity and gastro-esophageal reflux have been reported, as well as about the effects of weight loss and bariatric surgery on reflux. The aims of this study were to evaluate esophageal motility and gastro-esophageal acid circadian patterns in obese patients and to test the effects of vertical banded gastroplasty (VBG) on these parameters. METHODS: 14 obese subjects (BMI 36-53 kg/m2), 4 men, 10 women, 27-61 years old, admitted for elective bariatric surgery, underwent clinical evaluation, upper endoscopy, esophageal manometry and gastroesophageal pH monitoring. Evaluations were repeated 6 to 12 months after gastric surgery that consisted of a VBG (7 patients), accompanied in the other 7 patients with an anti-reflux procedure (fundoplication). Manometric and pH-metric findings in the obese patients were compared with a normal-weight control group before and after the two different surgical treatments. RESULTS: Gastro-esophageal reflux was significantly more frequent in obese (57.1%) than in control group (7.1%). Esophageal motility in obese subjects was not different from controls. After VBG alone, we found a reduction in basal lower esophageal sphincter (LES) pressure and an increase of acid reflux. When VBG was accompanied by fundoplication, basal LES pressure increased and acid reflux frequency decreased. CONCLUSIONS: Obesity is associated with gastroesophageal reflux. VBG reduced weight, but not gastro-esophageal acid reflux. Therefore, in our population, this operation cannot be considered as an antireflux procedure. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/15479599/Obesity_and_gastro_esophageal_acid_reflux:_physiopathological_mechanisms_and_role_of_gastric_bariatric_surgery_ L2 - https://dx.doi.org/10.1381/0960892041975622 DB - PRIME DP - Unbound Medicine ER -