Skip to main content
SpringerLink
Log in

“Normal Values of 24H Multichannel Intraluminal Impedance pH-Metry in a Greek Obese Population Based on Montreal Definition of Gerd”

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Although several studies reporting normal values of 24h multichannel intraluminal impedance pH (MIIpH) have been published, none of them has ever studied obese individuals. The purpose of this study is to determine overall frequency and duration of reflux episodes (acid and non-acid, supine-upright, post and preprandial) in obese asymptomatic volunteers.

Methods

Obese volunteers were enlisted during their preoperative evaluation for bariatric surgery. Volunteers had no gastroesophageal reflux disease (GERD) symptoms and no evidence of esophageal mucosal injury on endoscopy. Participants underwent a 24h MIIpH.

Results

In this prospective observational study, data of 22 obese individuals were analyzed. Mean age was 41.9 years and mean BMI was 47.1 kg/m2. Mean total reflux episodes was 55.6 and 95th percentile was 99.7. Mean percentage of total time with pH <4 was 2.59 % and 95th percentile was 8.57 %. Mean percentage of bolus exposure was 1.84 % with 95th percentile being 4.47 %. Postprandial acid reflux episodes were statistical significant more frequent in comparison to preprandial acid reflux episodes (19.41 vs. 15, p = 0.008). Mean acid clearance duration was 3.6 times higher than median bolus clearance duration (56.05 and 15.55 s, respectively, p = 0.868).

Conclusion

Our study is the first to provide normal values of 24h MIIpH of asymptomatic obese. Normal values of 24h MIIpH of obese asymptomatic individuals differ from the reported normal values of non-obese healthy individuals; having more reflux episodes and equal or slightly higher median bolus exposure and acid clearance. Our results imply that new cut-off values should be employed in order to define GERD in obese individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tutuian R, Vela MF, Shay SS, et al. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol. 2003;37(3):206–15.

    Article  PubMed  Google Scholar 

  2. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20.

    Article  PubMed  Google Scholar 

  3. Madalosso CA, Fornari F, Callegari-Jacques SM, et al. Performance of the Montreal consensus in the diagnosis of gastroesophageal reflux disease in morbidly obese patients. Obes Surg. 2008;18(6):668–74.

    Article  PubMed  Google Scholar 

  4. Tutuian R. Effects of bariatric surgery on gastroesophageal reflux. Curr Opin Gastroenterol. 2014;30(4):434–8.

    Article  PubMed  Google Scholar 

  5. Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD). http://www.sages.org.

  6. Shay S, Tutuian R, Sifrim D, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99(6):1037–43.

    Article  PubMed  Google Scholar 

  7. Zerbib F, des Varannes SB, Roman S, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22(10):1011–21.

    Article  PubMed  CAS  Google Scholar 

  8. Zentilin P, Iiritano E, Dulbecco P, et al. Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis. 2006;38(4):226–32.

    Article  PubMed  CAS  Google Scholar 

  9. Xiao YL, Lin JK, Cheung TK, et al. Normal values of 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring in the Chinese population. Digestion. 2009;79(2):109–14.

    Article  PubMed  Google Scholar 

  10. Zerbib F, Roman S, Bruley Des Varannes S, et al. Normal values of pharyngeal and esophageal 24-hour pH impedance in individuals on and off therapy and interobserver reproducibility. Clin Gastroenterol Hepatol. 2013;11(4):366–72.

    Article  PubMed  Google Scholar 

  11. Tolone S, Limongelli P, del Genio G, et al. Gastroesophageal reflux disease and obesity: do we need to perform reflux testing in all candidates to bariatric surgery? Int J Surg. 2014;12 Suppl 1:S173–7.

    Article  PubMed  Google Scholar 

  12. El-Serag. Role of obesity in GORD-related disorders. Gut. 2008;57(3):281–4.

    Article  PubMed  Google Scholar 

  13. El-Serag HB, Ergun GA, Pandolfino J, et al. Obesity increases oesophageal acid exposure. Gut. 2007;56(6):749–55.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hajar N, Castell DO, Ghomrawi H, et al. Impedance pH confirms the relationship between GERD and BMI. Dig Dis Sci. 2012;57(7):1875–9.

    Article  PubMed  Google Scholar 

  15. Wu YW, Tseng PH, Lee YC, et al. Association of esophageal inflammation, obesity and gastroesophageal reflux disease: from FDG PET/CT perspective. PLoS One. 2014;9(3), e92001.

    Article  PubMed  PubMed Central  Google Scholar 

  16. El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci. 2008;53(9):2307–12.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rubenstein JH, Morgenstern H, McConell D. Associations of diabetes mellitus, insulin, leptin, and ghrelin with gastroesophageal reflux and Barrett’s esophagus. Gastroenterology. 2013;145(6):1237–44.e1-5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Devendran N, Chauhan N, Armstrong D, et al. GERD and obesity: is the autonomic nervous system the missing link? Crit Rev Biomed Eng. 2014;42(1):17–24.

    Article  PubMed  Google Scholar 

  19. Ricci G, Amella C, Forti E, et al. 24-h pH-metry and multichannel intraluminal impedance monitoring in obese patients with and without gastroesophageal reflux disease symptoms. Obes Surg. 2011;21(1):48–53.

    Article  PubMed  Google Scholar 

  20. Akyüz F, Uyanıkoglu A, Ermis F, et al. Gastroesophageal reflux in asymptomatic obese subjects: an esophageal impedance-pH study. World J Gastroenterol. 2015;21(10):3030–4.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

  1. Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527, Athens, Greece

    Georgia Doulami, Stamatina Triantafyllou & Dimitrios Theodorou

  2. Department of Bariatric Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece

    Maria Natoudi, Konstantinos Albanopoulos & Evangelos Menenakos

  3. 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece

    Konstantinos Filis & Georgios Zografos

Authors
  1. Georgia Doulami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stamatina Triantafyllou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Natoudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos Albanopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evangelos Menenakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Konstantinos Filis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georgios Zografos
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dimitrios Theodorou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgia Doulami.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doulami, G., Triantafyllou, S., Natoudi, M. et al. “Normal Values of 24H Multichannel Intraluminal Impedance pH-Metry in a Greek Obese Population Based on Montreal Definition of Gerd”. OBES SURG 26, 126–131 (2016). https://doi.org/10.1007/s11695-015-1732-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1732-5

Keywords

Search

Navigation