Skip to main content
SpringerLink
Log in

Esophageal motility disorders in the morbidly obese population

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Most studies investigating esophageal motility among the morbidly obese have focused on the relationship between lower esophageal sphincter (LES) pressure and gastroesophageal reflux disease (GERD). Very few studies in the literature have examined motility disorders among the morbidly obese population in general outside the context of GERD. This study aimed to determine the prevalence of esophageal motility disorders in obese patients selected for bariatric surgery.

Methods

A total of 116 obese patients (81 women and 35 men) selected for laparoscopic gastric banding underwent manometric evaluation of their esophagus from January to March 2003. Tracings were retrospectively reviewed for the end points of LES resting pressure, LES relaxation, and esophageal peristalsis.

Results

The study patients had a body mass index (BMI) of 42.9 kg/m2, and a mean age of 48.6 years. The following abnormal manometric findings were demonstrated in 41% of the patients: nonspecific esophageal motility disorders (23%), nutcracker esophagus (peristaltic amplitude >180 mmHg) (11%), isolated hypertensive LES pressure (>35 mmHg) (3%), isolated hypotensive LES pressure (<12 mmHg) (3%), diffuse esophageal spasm (1%), and achalasia (1%). Only one patient with abnormal esophageal motility reported noncardiac chest pain.

Conclusions

Despite a high prevalence of esophageal dysmotility in our morbidly obese study population, there was a conspicuous absence of symptoms. Although the patients in this study were not directly questioned with regard to esophageal symptoms, several studies in the literature support our conclusion.

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

Fig. 1.

Similar content being viewed by others

References

  1. Backman L, Granstrom L, Lindahl J, Melcher A (1983) Manometric studies of lower esophageal sphincter in extreme obesity. Acta Chir Scand 149: 193–197

    PubMed  CAS  Google Scholar 

  2. Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD (2002) Gastroesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev 3: 9–15

    Article  PubMed  CAS  Google Scholar 

  3. Buchwald H (2005) Consensus Conference Statement: bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 200: 593–604

    Article  PubMed  Google Scholar 

  4. Clouse R, Staiano A (1983) Contraction abnormalities of the esophageal body in patients referred for manometry: a new approach to manometric classification. Dig Dis Sci 28: 784–791

    Article  PubMed  CAS  Google Scholar 

  5. Fisher B, Pennathur A, Mutnick J, Little A (1999) Obesity correlates with gastroesophageal reflux. Dig Dis Sci 44: 2290–2294

    Article  PubMed  CAS  Google Scholar 

  6. Frezza E, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roun-en-Y gastric bypass. Surg Endosc 16: 1027–1031

    Article  PubMed  CAS  Google Scholar 

  7. Grande L, Lacima G, Ros E, Pera M, Ascaso C, Visa J, Pera C. (1999) Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects. Am J Gastroenterol 94: 1795–1801

    Article  PubMed  CAS  Google Scholar 

  8. Greenstein RJ, Nissan A, Jaffin B (1998) Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg 8: 199–206

    Article  PubMed  CAS  Google Scholar 

  9. Hampel H, Abraham N, El-Serag H (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Int Med 143: 199–211

    PubMed  Google Scholar 

  10. Hong D, Kamath M, Wang S, Tabet J, Tougas G, Anvari M (2002). Assessment of the afferent vagal nerve in patients with gastroesophageal reflux. Surg Endosc 16: 1042–1045

    Article  PubMed  CAS  Google Scholar 

  11. Hong D, Khajanchee Y, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL. (2004) Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg 14: 744–749

    Article  PubMed  Google Scholar 

  12. Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, Sabbatini F, Mazzacca G, Ciacci C. (2002) Abnormal esophageal acid exposure is common in morbidly obese patients and improves after successful Lap-Band system implantation. Surg Endosc 16: 1631–1635

    Article  PubMed  CAS  Google Scholar 

  13. Jaffin B, Knoeplmacher P, Greenstein R (1999) High prevalence of asymptomatic esophageal motility disorders among morbidly obese patient. Obes Surg 9: 390–395

    Article  PubMed  CAS  Google Scholar 

  14. Kjellin A, Ramel S, Rossner S, Thor K (1996) Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 1: 1047–1051

    Google Scholar 

  15. Lagergren J, Bergstrom R, Nyren O (2001) No relation between body mass and gastroesophageal reflux symptoms in a Swedish population–based study. Gut 48: 578–579

    Article  Google Scholar 

  16. Lundell L, Ruth M, Sandberg N, Bove-Nielsen M (1995) Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 40: 1632–1635

    Article  PubMed  CAS  Google Scholar 

  17. Mercer C, Rue C, Hanelin L, Hill LD (1985) Effect of obesity on esophageal transit. Am J Surg 149: 177–181

    Article  PubMed  CAS  Google Scholar 

  18. O’brien TF Jr (1980) Lower esophageal sphincter pressure (LESP) and esophageal function in obese humans. J Clin Gastroenterol 2: 145–148

    Article  PubMed  Google Scholar 

  19. Peterson H, Rothschild M, Weinberg C, Fell RD, McLeish KR, Pfeifer MA. (1988) Body fat and the activity of the autonomic nervous system. N Engl J Med 318: 1077–1083

    Article  PubMed  CAS  Google Scholar 

  20. Richter J, Wu W, Johns D, Blackwell JN, Nelson JL 3rd, Castell JA, Castell DO. (1987) Esophageal manometry in 95 healthy adult volunteers: variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32: 583–592

    Article  PubMed  CAS  Google Scholar 

  21. Sugarbaker D, Kearney D, Richards W (1993) Esophageal physiology and pathophysiology. Surg Clin North Am 73: 1101–1116

    PubMed  CAS  Google Scholar 

  22. Suter M, Dorta G, Giusti V, Calmes JM (2004) Gatroesophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14: 959–966

    Article  PubMed  CAS  Google Scholar 

  23. Suter M, Dorta G, Giusti V, Calmes JM (2005) Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 140: 639–643

    Article  PubMed  Google Scholar 

  24. Verset D, Houben JJ, Gay F, Elcheroth J, Bourgeois V, Van Gossum A. (1997) The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci 42: 2333–2337

    Article  PubMed  CAS  Google Scholar 

  25. Weihrauch TR, Vallerius P, Alpers H, Ewe K (1980) Assessment of various factors influencing esophageal pressure measurement: II. Significance of physiological factors in intraluminal manometry. Klinische Wochenschrift 58: 287–292

    Article  PubMed  CAS  Google Scholar 

  26. Weiss H, Nehoda H, Labeck B, Peer-Kuhberger MD, Klingler P, Gadenstatter M, Aigner F, Westscher GJ. (2000) Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 180: 479–482

    Article  PubMed  CAS  Google Scholar 

  27. Wilson L, Wenzhou M, Hirschowitz B (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94: 2840–2844

    Article  PubMed  CAS  Google Scholar 

  28. Xing J, Chen J (2004) Alterations of gastrointestinal motility in obesity. Obes Res 12: 1723–1732

    Article  PubMed  Google Scholar 

  29. Zacchi P, Mearin F, Humbert P, Formiguera X, Malagelada JR (1991) Effect of obesity on gastroesophageal resistance to flow in man. Dig Dis Sci 36: 1473–1480

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Bariatric Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    J. S. Koppman, L. Poggi, S. Szomstein, A. Ukleja, A. Botoman & R. Rosenthal

Authors
  1. J. S. Koppman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Poggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Szomstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Ukleja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Botoman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Rosenthal.

Additional information

Podium presentation at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), 26–29 April 2006, Dallas, TX, USA

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koppman, J.S., Poggi, L., Szomstein, S. et al. Esophageal motility disorders in the morbidly obese population. Surg Endosc 21, 761–764 (2007). https://doi.org/10.1007/s00464-006-9102-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-9102-y

Keywords

Search

Navigation