title: Increased Belching After Sleeve Gastrectomy.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is considered to be an effective procedure for patients with morbid obesity. Belching is frequently reported after this procedure, but it has not been well studied in the bariatric population. This study aims to assess the changes in belching before and after sleeve gastrectomy, as measured with impedance monitoring.
  
  
  METHODS
  In a prospective study, patients underwent 24-h pH-impedance monitoring before and 3 months after LSG. Using this technique, belches can be identified. Preoperative and postoperative upper gastrointestinal symptoms were assessed using the Reflux Disease Questionnaire (RDQ).
  
  
  RESULTS
  Fifteen patients (1 M/14 F, mean age 42.2 ± 11.0 years, mean weight 134.5 ± 21.1 kg, mean BMI 46.4 ± 6.0 kg/m(2)) participated in this study. Belching occurred significantly more often after LSG, with an increase in symptom score from 2.9 ± 2.6 before to 5.3 ± 3.5 3 months after LSG (p = 0.04). The total number of gastric belches increased from 29.7 ± 11.7 before to 59.5 ± 38.3/24 h 3 months after LSG (p = 0.03). The total number of supragastric belches did not change after LSG. The number of swallows decreased from 746.9 ± 302.4 before to 555.7 ± 172.5 3 months after the procedure (p = 0.03). The number of air swallows tended to decrease (p = 0.08). Esophageal acid exposure increased significantly, from 3.7 ± 2.9 % before to 12.6 ± 10.5 % after LSG (p = 0.01).
  
  
  CONCLUSIONS
  Subjectively (as reported by patients) and objectively (as measured by impedance monitoring), an increase in gastric belches is seen after LSG, while the number of (air) swallows tends to decrease after the procedure and the incidence of supragastric belches remains constant. The altered anatomy as well as increased gastroesophageal reflux after LSG may play a role in the increase of belching.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. J.S.Burgerhart@umcutrecht.nl.|Dutch Obesity Clinic, Hilversum, The Netherlands. J.S.Burgerhart@umcutrecht.nl.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Burgerhart
authors.affiliation: Dutch Obesity Clinic, Hilversum, The Netherlands. p.van.de.meeberg@slingeland.nl.|Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands. p.van.de.meeberg@slingeland.nl.
authors.forename: Paul C
authors.initials: PC
authors.lastname: van de Meeberg
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. femkemauritz@gmail.com.
authors.forename: Femke A
authors.initials: FA
authors.lastname: Mauritz
authors.affiliation: Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands. erik.schoon@cze.nl.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. frans.smulders@cze.nl.
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Smulders
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. p.d.siersema@umcutrecht.nl.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. a.j.smout@amc.uva.nl.
authors.forename: André J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D000328:Adult; D003679:Deglutition; D004884:Eructation / Q000209:etiology*; D050782:Esophageal pH Monitoring; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011446:Prospective Studies
keywords: Belching; Impedance monitoring; Reflux; Sleeve gastrectomy; Swallows