title: Dysfunction of the lower esophageal sphincter and dysmotility of the tubular esophagus in morbidly obese patients.
abstract: 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.
authors.affiliation: Department of General, Visceral, and Transplant Surgery, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. Markus.kueper@med.uni-tuebingen.de
authors.forename: M A
authors.initials: MA
authors.lastname: Küper
authors.forename: K M
authors.initials: KM
authors.lastname: Kramer
authors.forename: A
authors.initials: A
authors.lastname: Kirschniak
authors.forename: A
authors.initials: A
authors.lastname: Kischniak
authors.forename: M
authors.initials: M
authors.lastname: Zdichavsky
authors.forename: J H
authors.initials: JH
authors.lastname: Schneider
authors.forename: D
authors.initials: D
authors.lastname: Stüker
authors.forename: T
authors.initials: T
authors.lastname: Kratt
authors.forename: A
authors.initials: A
authors.lastname: Königsrainer
authors.forename: F A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: 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