Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery.
BACKGROUND
Obesity is a predisposing factor to gastro-esophageal reflux disease (GERD), but esophageal function remains poorly studied in morbidly obese patients and could be modified by bariatric surgery.


METHODS
Every morbidly obese patient (BMI > or =40 kg/m2 or > or =35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).


RESULTS
Before surgery, 100 patients were included (84 F, age 38.4 +/- 10.9 years, BMI 45.1 +/- 6.02 kg/m2), of whom 73% reported GERD symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%; 69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP n = 15/36). The DeMeester score (normal < 14.72) was significantly decreased after RYGBP (24.8 +/- 13.7 before vs. 5.8 +/- 4.9 after; P < 0.001) but tended to increase after AGB (11.5 +/- 5.1 before vs. 51.7 +/- 70.7 after; P = 0.09), with severe dyskinesia in 2 cases.


CONCLUSIONS
GERD and LES incompetence are highly prevalent in morbidly obese patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of pH-metric data with occasional severe dyskinesia after AGB.
Merrouche
Mohamed
M
AP-HP, Hôpital Louis Mourier, University Paris VII, Service d'Hépato-Gastroentérologie, Colombes, France.
Sabaté
Jean-Marc
JM
Jouet
Pauline
P
Harnois
Florence
F
Scaringi
Stefano
S
Coffin
Benoit
B
Msika
Simon
S
D000293:Adolescent; D000328:Adult; D015154:Esophageal Motility Disorders / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome