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Obesity Surgery

, Volume 19, Issue 11, pp 1522–1529 | Cite as

Multichannel Intraluminal Impedance Measurement of Gastroesophageal Reflux in Patients with Different Stages of Morbid Obesity

  • Juliane M.E. Schneider
  • Björn L.D.M. Brücher
  • Markus Küper
  • Kathrin Saemann
  • Alfred Königsrainer
  • Joachim H. Schneider
Research Article

Abstract

Background

Obesity is now one of the world’s major chronic diseases. The etiology of the severe comorbid conditions associated with morbid obesity is not fully understood, and in particular the relationship between gastroesophageal reflux and obesity.

Methods

Sixty-seven patients were enrolled in this prospective study. Patients and control individuals were divided into four subgroups according to their body mass index (BMI). Esophageal motility was assessed using a conventional water-perfused esophageal manometry catheter, and 24-h pH-metry was carried out using multichannel intraluminal impedance equipment.

Results

In the group with the highest BMI (>50), contraction amplitudes in the middle and distal esophagus were significantly higher in comparison both with the control group and groups with a lower BMI (P < 0.05). Lower esophageal sphincter pressure was reduced in the majority of patients with morbid obesity and differed significantly from the control group (P < 0.001). Significant differences between the control group and the patient groups were also observed on 24-h pH-metry (P < 0.05). The 24-h impedance measurements distinguished between acid and nonacid status and between the upright and recumbent positions. The total number of reflux episodes differed significantly between the control and patient groups and between groups III and IV, with lower and higher BMI values (P < 0.008 and P < 0.05, respectively).

Conclusions

The impedance data obtained in this study confirm that patients with morbid obesity are at risk of developing gastroesophageal reflux disease. However, there is no evidence of a direct correlation between the severity of reflux and the extent of obesity.

Keywords

Bioelectric impedance Morbid obesity Reflux GERD pH-metry 

References

  1. 1.
    WHO/NUT/NCD. Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity, Geneva, 3–5 June 1997. Geneva: World Health Organization; 1998.Google Scholar
  2. 2.
    Spritzer DA. Obesity epidemic migrates east. CMAJ. 2004;171:1159.PubMedGoogle Scholar
  3. 3.
    Brownell KE, Yach D. Lessons from a small country about the global obesity crisis. Global Health. 2006;2:11.CrossRefPubMedGoogle Scholar
  4. 4.
    Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Locke GR 3rd, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Fischer BL, Pennathur A, Mutnick JL, et al. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290–4.CrossRefGoogle Scholar
  7. 7.
    Nilsson M, Lundegardh G, Carling L, et al. Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gastroenterol. 2002;37:626–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I epidemiologic follow up study. First National Health and Nutrition Examination Survey. Ann Epidemiol. 1999;9:424–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Lundell L, Ruth M, Sandberg N, et al. Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci. 1995;40:1632–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Lam HG, Breumelhof R, Roelofs JM, et al. What is the optimal time window in symptom analysis of 24-hour esophageal pressure and pH data? Dig Dis Sci. 1994;39:402–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Fass J, Silny J, Braun J, et al. Measuring esophageal motility with a new intraluminal impedance device: first clinical results in reflux patients. Scand J Gastroenterol. 1994;29:693–702.CrossRefPubMedGoogle Scholar
  13. 13.
    Silny J. Intraluminal multiple electric impedance procedure for measurement of gastrointestinal motility. J Gastrointest Motil. 1991;3:151–62.Google Scholar
  14. 14.
    Castell DO, Vela M. Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux. Am J Med. 2001;111(Suppl 8A):157S–9S.CrossRefPubMedGoogle Scholar
  15. 15.
    Dreuws B, Fass J, Büchin P, et al. Combined pH measurement and multiple impedance variation assessments—validation of a new technique for detection of non-acid reflux in the esophagus; in German. Langenbecks Arch Chir Suppl Kongressbd. 1998;115:1143–5.Google Scholar
  16. 16.
    Sifrim D, Silny J, Holloway RH, et al. Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electric impedance. Gut. 1999;44:47–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Sifrim D, Holloway R, Silny J, et al. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:647–55.CrossRefPubMedGoogle Scholar
  18. 18.
    Tutuian R, Vela MF, Balaji NS, et al. Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers. Clin Gastroenterol Hepatol. 2003;1:174–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Sifrim D, Castell D, Dent J, et al. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Schneider JH, Crookes P, Becker HD. Four-channel sleeve catheter for prolonged measurement of lower esophageal sphincter pressure. Dig Dis Sci. 1999;44:2456–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Mann GV. The influence of obesity on health (first of two parts). N Engl J Med. 1974;291:178–85.PubMedGoogle Scholar
  22. 22.
    Kenchaiah S, Evens JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Calle EE, Rodrigues C, Walker-Thurmond K, et al. Overweight, obesity and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.CrossRefPubMedGoogle Scholar
  24. 24.
    Powell A, Teichtahl AJ, Wluka AE, et al. Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. Br J Sports Med. 2005;39:4–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Nocon M, Labenz J, Jaspersen D, et al. Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study. J Gastroenterol Hepatol. 2007;22:1728–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Piretta L, Alghisi F, Anzini F, et al. Prevalence of overweightedness with gastro-esophageal reflux. World J Gastroenterol. 2007;13:4602–5.PubMedGoogle Scholar
  27. 27.
    Jansson C, Nordenstedt H, Johannsson S, et al. Relationship between gastroesophageal symptoms and socioeconomic factors: a population-based study (the HUNT Study). Clin Gastroenterol Hepatol. 2007;5:1029–24.CrossRefPubMedGoogle Scholar
  28. 28.
    Schneider JH, Kramer KM, Königsrainer A, et al. Transient lower esophageal sphincter relaxation in morbid obesity. Surg Endosc. 2008 [in press].Google Scholar
  29. 29.
    Stene-Larsen G, Weberg R, Frøyshov L, et al. Relationship of overweight to hiatal hernia and reflux oesophagitis. Scand J Gastroenterol. 1988;23:427–32.CrossRefPubMedGoogle Scholar
  30. 30.
    Sugerman H, Windsor A, Bessos M, et al. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med. 1997;241:71–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med. 1991;151:448–54.CrossRefPubMedGoogle Scholar
  33. 33.
    Schneider JH, Kramer KM, Königsrainer A, et al. Ambulatory pH: monitoring with a wireless system. Surg Endosc. 2007;21:2076–80.CrossRefPubMedGoogle Scholar
  34. 34.
    Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992;87:1102–11.PubMedGoogle Scholar
  35. 35.
    El-Serag HB, Ergun GA, Pandolfino J, et al. Obesity increases oesophageal acid exposure. Gut. 2007;56:749–55.CrossRefPubMedGoogle Scholar
  36. 36.
    Sifrim D, Holloway RH, Silny J, et al. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH impedance recordings. Gastroenterology. 2001;120:1588–98.CrossRefPubMedGoogle Scholar
  37. 37.
    Vela M, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.CrossRefPubMedGoogle Scholar
  38. 38.
    Klaus A, Gruber I, Wetscher G, et al. Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg. 2006;141:247–51.CrossRefPubMedGoogle Scholar
  39. 39.
    Suter M, Dorta G, Guisti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.CrossRefPubMedGoogle Scholar
  40. 40.
    Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Herbella FA, Sweet MP, Tedesco P, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–90.CrossRefPubMedGoogle Scholar
  42. 42.
    Barak N, Ehrenpreis ED, Harrison JR, et al. Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev. 2002;3:9–15.CrossRefPubMedGoogle Scholar
  43. 43.
    Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15:1225–32.CrossRefPubMedGoogle Scholar
  44. 44.
    Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbid obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.CrossRefPubMedGoogle Scholar
  45. 45.
    Schneider JH, Kramer KM, Königsrainer A, et al. The lower esophageal sphincter strength in patients with gastroesophageal reflux before and after laparoscopic Nissen fundoplication. Dis Esophagus. 2007;20:58–62.CrossRefPubMedGoogle Scholar
  46. 46.
    Cortesini C, Marcuzzo G, Pucciani F. Relationship between mixed acid–alkaline gastroesophageal reflux and esophagitis. Ital J Surg Sci. 1985;15:9–15.PubMedGoogle Scholar
  47. 47.
    Reddy H, Arendt-Nielsen L, Staahl C, et al. Gender differences in pain and biomedical responses after acid sensitization of the human esophagus. Dig Dis Sci. 2005;50:2050–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Drewes AM, Reddy H, Pedersen J, et al. Multimodal pain stimulations in patients with grade B oesophagitis. Gut. 2005;55:926–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Juliane M.E. Schneider
    • 1
  • Björn L.D.M. Brücher
    • 1
  • Markus Küper
    • 1
  • Kathrin Saemann
    • 1
  • Alfred Königsrainer
    • 1
  • Joachim H. Schneider
    • 1
  1. 1.Tübingen Comprehensive Cancer Center, Department of SurgeryUniversity of TübingenTübingenGermany

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