Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance.
BACKGROUND
Morbid obesity is associated with gastroesophageal reflux disease (GERD), and both have an independent association with motility disorders. Impaired esophageal function is thought to play a role in the development of dysphagia after fundoplication and bariatric procedures (especially restrictive procedures). The authors aimed to define both the physiology and the underlying pathophysiology of swallowing using a novel technique, multichannel intraluminal impedance (MII), which can accurately determine the clearance of a swallowed bolus through the esophagus, in combination with traditional manometry, which can measure peristalsis.


METHODS
Simultaneous MII, manometry, and pH monitoring were performed for 10 asymptomatic subjects, 22 consecutive nonobese patients with GERD (GERD), and 22 consecutive morbidly obese patients with GERD (MO-GERD) who were under evaluation for antireflux and bariatric surgery at the University of Washington. In this study, MII was defined as abnormal if less than 80% of swallowed liquid boluses cleared the esophagus completely.


RESULTS
All GERD and MO-GERD patients had abnormal pH monitoring. The manometric findings were similar for the GERD and MO-GERD patients. All the asymptomatic subjects had normal manometry and impedance test results. Abnormal manometry would have predicted that approximately 23% of GERD and MO-GERD patients had defective emptying. However, when measured with impedance, esophageal clearance was found to be defective in two times as many GERD and nearly three times as many MO-GERD patients.


CONCLUSIONS
In patients with GERD, impedance often detects impairments in esophageal motility not identified by manometry. Morbidly obese patients with GERD have a higher incidence of impaired esophageal motility than nonobese patients with GERD. This may have implications for bariatric procedures, especially those that are restrictive.
The Swallowing Center, Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA.
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Quiroga
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Cuenca-Abente
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Flum
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Dellinger
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Oelschlager
D002940:Circadian Rhythm; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000453:epidemiology / Q000209:etiology; D004947:Esophagus / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008365:Manometry; D009767:Obesity, Morbid / Q000150:complications*