Dysfunction of the lower esophageal sphincter and dysmotility of the tubular esophagus in morbidly obese patients.
BACKGROUND
Morbid obesity is associated with gastroesophageal reflux (GERD). The aim of this prospective study was to determine esophageal motility in asymptomatic morbidly obese patients and compare it to non-obese individuals.


METHODS
Forty-seven morbidly obese patients without GERD symptoms and 15 normal weight individuals were divided into four groups according to their body mass index (BMI; group I, <30 kg/m2; group II, 35-39.9 kg/m2; group III, 40-49.9 kg/m2; group IV, >or=50 kg/m2). Standard stationary water-perfused manometry was performed for the assessment of anatomy and function of the lower esophageal sphincter (LES). Twenty-four-hour ambulatory pH-metry and measurement of esophageal motility were performed with a microtransducer sleeve catheter. Data are given as mean+/-SD, and the results of groups II-IV were compared to the non-obese individuals from group I.


RESULTS
Patients with morbid obesity had significantly lower LES pressures than non-obese individuals (I, 15.1+/-4.9; II-IV, 10.5+/-5.4, mmHg, p<0.05 vs. I) and showed an altered esophageal motility with respect to contraction frequency (I, 1.8+/-0.7/min; II-IV, 3.6+/-2.5/min; p<0.05 vs. I) and contraction amplitude (I, 38+/-12 mmHg; II-IV, 33+/-17 mmHg; p<0.05 vs. I). Furthermore, these patients had significantly higher DeMeester scores than non-obese individuals. Length and relaxation of the LES as well as propulsion velocity of the tubular esophagus did not differ.


CONCLUSIONS
Patients with morbid obesity (=BMI>40 kg/m2) have a dysfunction of the LES and an altered esophageal motility, even when they are asymptomatic for GERD symptoms.
Küper
M A
MA
Department of General, Visceral, and Transplant Surgery, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. Markus.kueper@med.uni-tuebingen.de
Kramer
K M
KM
Kirschniak
A
A
Kischniak
A
A
Zdichavsky
M
M
Schneider
J H
JH
Stüker
D
D
Kratt
T
T
Königsrainer
A
A
Granderath
F A
FA
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000503:physiopathology*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction; D009767:Obesity, Morbid / Q000175:diagnosis / Q000503:physiopathology*; D011312:Pressure; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult