title: Gastroesophageal reflux disease and obesity: do we need to perform reflux testing in all candidates to bariatric surgery?
abstract: BACKGROUND
  Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and esophageal erosions. However the relationship between obesity and GERD is still a subject of debate. In fact, if in most cases bariatric surgery can diminish reflux by losing a large amount of fat, on the other hand some restrictive procedure can worsen or cause the presence of GERD. Thus, it is unclear if patients candidate to bariatric surgery have to perform pre-operative reflux testing or not.
  
  
  OBJECTIVE
  of the study was to verify the presence of GERD patterns in patients candidate to surgery and the need of pre-operative reflux testing.
  
  
  METHODS
  All patients underwent to a standardized questionnaire for symptoms severity (GERQ), upper endoscopy, high resolution manometry (HRiM) and impedance pH-monitoring (MII-pH). Patients were stratified into: group 1 (negative for both GERQ and endoscopy), group 2 (positive for GERQ and negative for endoscopy), group 3 (positive for both GERQ and endoscopy). A healthy-volunteers group (HV) was assessed.
  
  
  RESULTS
  One hundred thirty-nine subjects (obese, 124; HV normal weight, 15) were studied. Group 1 showed comparable mean LES pressure, peristaltic function, bolus transport and presence of hiatal hernia than HV. Group 2 showed a reduction of these parameters, while group 3 showed a statistical significant reduction in LES pressure, peristaltic function, bolus transport and increase in presence of hiatal hernia. At MII-pH, Group 1 showed a not significant increase in reflux patterns; group 2 and 3 showed a significant increase in esophageal acid exposure and in number of refluxes (both acid and weakly acid), with group 3 showing the higher grade of reflux pattern.
  
  
  CONCLUSIONS
  Obese subjects with pre-operative presence of GERD symptoms and endoscopical signs could be tested with HRM and MII-pH before undergoing bariatric surgery, especially for restrictive procedures. On the other hand, obese patients without any sign of GERD could not be tested for reflux, showing similar patterns to HV.
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: salvatore.tolone@unina2.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Amoroso
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Schettino
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Avellino
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Gili
authors.affiliation: Department of Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D016022:Case-Control Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
keywords: Bariatric surgery; GERD; High resolution manometry; Impedance-pH; Obesity