Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery. A Prospective Study.
BACKGROUND
Before bariatric surgery, the necessity of routine upper gastrointestinal endoscopy is controversial, and guidelines recommend endoscopy in symptomatic cases. However, impaired visceral sensation occurring in obese patients may be misleading. The purpose of the study is to evaluate prospectively the prevalence of gastrointestinal symptoms, endoscopic findings, and the relation between symptoms and endoscopic findings in obese patients before surgery.


METHODS
One hundred forty-two consecutive patients candidate to primary bariatric surgery filled out the validated Rome III symptomatic questionnaire and performed endoscopy.


RESULTS
With a median age of 41 years and BMI of 44 Kg/m(2), 83% were females. Symptoms were referred by 43% of patients: gastroesophageal reflux disease (GERD) (27.9%) and dyspepsia (24.6%), subdivided in postprandial distress (PDS) (66.7%) and epigastric pain (33.3%) syndromes. Of GERD patients, 19.7% presented concomitantly PDS. Belching was present in 8.2% and nausea and/or vomiting in 1.6% of patients. At endoscopy, one or more lesions were present in 47.1% of the patients: erosive esophagitis (5.6%), hiatal hernia (23.2%), gastroduodenal erosions (6.3%), and peptic ulcers (3.5%). At histology, 24% of patients have Helicobacter pylori infection, and its prevalence in gastroduodenal erosions and ulcers was 22.2 and 60%, respectively. Surprisingly, in patients with peptic lesions H. pylori-negative, no chronic use of NSAIDs was reported. Analyzing the coexistence of symptoms and lesions, these resulted equally distributed beyond the presence of symptoms, being present in 44.2 and 49.4% of symptomatic and asymptomatic patients, respectively.


CONCLUSIONS
The presence of symptoms cannot be considered as a valuable guide to indicate endoscopy since the majority of endoscopic lesions were asymptomatic and not H. pylori-related.
Department of Internal Medicine and Medical Specialties, University of Rome "Sapienza", viale del Policlinico 155, 00161, Rome, Italy. mcarabotti@yahoo.it.
Marilia
M
Carabotti
Department of Medical Surgical Sciences and Biotechnology, University of Rome "Sapienza", Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
Marcello
M
Avallone
Department of Medical Surgical Sciences and Biotechnology, University of Rome "Sapienza", Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
Fabrizio
F
Cereatti
Department P. Stefanini, University of Rome "Sapienza", viale del Policlinico 155, 00161, Rome, Italy.
Alessandro
A
Paganini
AUSL Viterbo Ospedale Andosilla, via Ferretti 169, 01033, Civita Castellana, VT, Italy.
Francesco
F
Greco
Department of Internal Medicine and Medical Specialties, University of Rome "Sapienza", viale del Policlinico 155, 00161, Rome, Italy.
Annunziata
A
Scirocco
Department of Internal Medicine and Medical Specialties, University of Rome "Sapienza", viale del Policlinico 155, 00161, Rome, Italy.
Carola
C
Severi
Department of Medical Surgical Sciences and Biotechnology, University of Rome "Sapienza", Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
Gianfranco
G
Silecchia
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D004415:Dyspepsia / Q000209:etiology*; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D019518:Postprandial Period; D011300:Preoperative Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
Bariatric surgery; GERD; Gastrointestinal disorders; Obesity; Pre-surgical endoscopy