title: Intragastric balloon insertion increases the frequency of erosive esophagitis in obese patients.
abstract: BACKGROUND
  The BioEnterics intragrastric balloon (BIB) has been successfully used for treatment with BMI >35 or BMI >40. Gastroesophageal reflux (GER) symptoms are sometimes reported to occur and/or to worsen in patients with BIB, with a variable onset of erosive esophagitis (EE). The aim of this study was to investigate the prevalence and the severity of esophagitis after BIB placement.
  
  
  METHODS
  121 patients (93 F, 28 M, mean age 45 (19-65), mean BMI 41.5 (30-63.5) were studied. Patients with severe esophagitis (grade C-D Los Angeles (LA) classification), gastric or duodenal ulcers were excluded from the BIB treatment. After BIB placement, proton-pump inhibitors (PPI) were administered in the first month to each patient. The BIB was removed after 6 months. The presence of EE and related severity by LA classification were recorded
  
  
  RESULTS
  Before BIB insertion, 18 patients (15%) showed mild EE (16 grade A and 2 grade B). After BIB removal, EE was observed in 22 patients (18.2%): 11 grade A, 7 grade B, 4 grade C-D. The difference in the prevalence of EE after BIB was statistically significant (Wilcoxon's test P =0.030).
  
  
  CONCLUSIONS
  EE prevalence was significantly increased after BIB placement. We suggest that EE due to enhanced GER could be considered as an adverse effect of such treatment. We therefore recommend maintaining intragastric acid suppression with PPIs during the 6 months of BIB placement.
authors.affiliation: Endoscopia Digestiva, Casa di Cura Malatesta Novello, Cesena, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Rossi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bersani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ricci
authors.forename: Chiara
authors.initials: C
authors.lastname: Petrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: DeFabritiis
authors.forename: Vittorio
authors.initials: V
authors.lastname: Alvisi
mesh_terms: D000328:Adult; D000368:Aged; D004941:Esophagitis / Q000145:classification / Q000453:epidemiology*; D005260:Female; D015905:Gastric Balloon / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012720:Severity of Illness Index