title: The contribution of intrabolus pressure to symptoms induced by gastric banding.
abstract: OBJECTIVE
  Mechanisms that ultimately lead to dysphagia are still not totally clear. Patients with laparoscopic gastric banding (LAGB) often complain about dysphagia, regurgitation and heartburn. Our aim was to evaluate the contribution of intrabolus pressure to symptoms of gastric banding.
  
  
  METHODS
  This study investigated 30 patients with LAGB before and 3 months after conversion to Roux-en-Y gastric bypass (RYGB), evaluating symptoms with a 7-point-Likert-scale and esophageal peristalsis, esophageal bolus transit and intrabolus pressure changes using combined impedance-manometry.
  
  
  RESULTS
  Conversion from LAGB to RYGB leads to a significant reduction in dysphagia (1.9 +/- 0.4 vs. 0.0 +/- 0.0; p< 0.01) and regurgitation (4.2 +/- 0.4 vs. 0.1 +/- 0.1; p< 0.01) symptom scores. For liquid swallows we found a modest but significant correlation between the intensity of dysphagia and intrabolus pressure (r=0.11; p<0.05) and the intensity of regurgitation and intrabolus pressure for viscous swallows (r=0.12, p<0.05) in patients with LAGB. There was a significant (p< 0.05) reduction in intrabolus pressure at 5 cm above LES before (liquid 10.6 +/-1.0; viscous 13.5 +/- 1.5) and after (liquid 6.4 +/- 0.6; viscous 10.5 +/- 0.9) conversion from LAGB to RYGB.
  
  
  CONCLUSIONS
  Current data suggest that intraesophageal pressure during bolus presence in the distal esophagus contributes to the development but not to the intensity of dysphagia and regurgitation.
authors.affiliation: Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern, Switzerland. radu.tutuian@insel.ch.
authors.forename: Claudia
authors.initials: C
authors.lastname: Preissler
authors.affiliation: Division of Gastroenterology, Kantonsspital St. Gallen, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Krieger-Grübel
authors.affiliation: Division of Gastroenterology, Kantonsspital St. Gallen, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Borovicka
authors.affiliation: Division of Gastroenterology, University Clinics, Zürich Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.affiliation: Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern, Switzerland.
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
mesh_terms: D000328:Adult; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011312:Pressure; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D012720:Severity of Illness Index