title: Symptoms, endoscopic findings and reflux monitoring results in candidates for bariatric surgery.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is common in patients with obesity. Diagnosing GERD is important as bariatric operations have different influence on GERD. We assessed reflux symptoms and objective findings prior to surgery.
  
  
  METHODS
  Work-up included esophageal symptoms quantification by VAS-scores, esophagogastroduodenoscopy (EGD) and 24-h impedance-pH (imp-pH) monitoring off PPI therapy. Imp-pH was classified as abnormal if either %time pH<4 was abnormal, total number of reflux episodes was elevated or symptom index (SI) was positive.
  
  
  RESULTS
  Among 100 consecutive patients (68F, age 40±11years, BMI 44.9±6.9kg/m2) 54% reported heartburn and/or regurgitation, 71% had objective evidence of GERD (38% endoscopic lesions and 33% only abnormal imp-pH results). Imp-pH was superior to EGD in identifying GERD (sensitivity 85% vs. 54%, p<0.01). Symptomatic and asymptomatic patients had similar prevalence of esophageal lesions (37% vs. 39%) and abnormal imp-pH findings (68% vs. 50%). Sixty nine percent of patients with abnormal %time pH<4 had a normal number of reflux episodes.
  
  
  CONCLUSIONS
  Half of patients with obesity reported typical GERD symptoms and >70% had evidence of GERD. Poor acid clearance was the main mechanisms. Since typical reflux symptoms don't predict objective findings, endoscopy and reflux monitoring should be part of the surgery work-up especially before restrictive procedures.
authors.affiliation: Department of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: benjamin.heimgartner@insel.ch.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Heimgartner
authors.affiliation: Department of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Marcus
authors.initials: M
authors.lastname: Herzig
authors.affiliation: Department of Visceral Surgery, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Borbély
authors.affiliation: Department of Visceral Surgery, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Dino
authors.initials: D
authors.lastname: Kröll
authors.affiliation: Department of Visceral Surgery, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Nett
authors.affiliation: Department of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis*; D016145:Endoscopy, Digestive System / Q000379:methods*; D050782:Esophageal pH Monitoring / Q000379:methods*; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011237:Predictive Value of Tests; D057234:Preoperative Period; D063189:Symptom Assessment
keywords: 24h-impedance-pH metry; Bariatric surgery; Gastroesophageal reflux disease (GERD); Obesity