title: pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Gastro-oesophageal reflux disease (GORD) is a common obesity-related co-morbidity that is assessed objectively by 24-h pH monitoring. Some concerns have been raised regarding the risk of de novo GORD or exacerbation of pre-existing GORD after laparoscopic sleeve gastrectomy. Here, 24-h pH monitoring was used to assess the influence of laparoscopic sleeve gastrectomy on postoperative GORD in obese patients with or without preoperative GORD.
  
  
  METHODS
  From July 2012 to September 2014, all patients scheduled for laparoscopic sleeve gastrectomy were invited to participate in a prospective follow-up. Patients who underwent preoperative 24-h pH monitoring were asked to repeat the examination 6 months after operation. GORD was defined as an oesophageal pH < 4 for at least 4·2 per cent of the total time recorded.
  
  
  RESULTS
  Of 89 patients, 76 had preoperative pH monitoring for GORD evaluation and 50 had postoperative reassessment. Patients without (group 1, 29 patients) or with (group 2, 21 patients) preoperative GORD were similar regarding age, sex ratio and body mass index. In group 1, the median (i.q.r.) total time at pH < 4 was significantly higher after surgery than before: 5·6 (2·5-9·5) versus 1·6 (0·7-2·9) per cent (P < 0·001). Twenty of the 29 patients experienced de novo GORD as determined by 24-h pH monitoring (P < 0·001). In group 2, total time at pH < 4 after surgery was no different from the preoperative value: 5·9 (3·9-10·7) versus 7·7 (5·2-10·3) per cent (P = 0·296).
  
  
  CONCLUSIONS
  Laparoscopic sleeve gastrectomy was associated with de novo GORD in over two-thirds of patients, but did not seem to exacerbate existing GORD.
authors.affiliation: Departments of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: J
authors.initials: J
authors.lastname: Thereaux
authors.affiliation: Departments of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: C
authors.initials: C
authors.lastname: Barsamian
authors.affiliation: Departments of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: M
authors.initials: M
authors.lastname: Bretault
authors.affiliation: Departments of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: H
authors.initials: H
authors.lastname: Dusaussoy
authors.affiliation: Departments of Gastroenterology, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: D
authors.initials: D
authors.lastname: Lamarque
authors.affiliation: Departments of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Bouillot
authors.affiliation: Departments of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.|Institut National de la Santé et de la Recherche Médicale UMS 011, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Czernichow
authors.affiliation: Departments of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique - Hôpitaux de Paris, Boulogne, France.
authors.forename: C
authors.initials: C
authors.lastname: Carette
mesh_terms: D000328:Adult; D050782:Esophageal pH Monitoring / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D013997:Time Factors