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Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery

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Background

Obesity is a predisposing factor to gastro- esophageal reflux disease (GERD), but esophageal function remains poorly studied in morbidly obese patients and could be modified by bariatric surgery.

Methods

Every morbidly obese patient (BMI ≥40 kg/m2 or ≥35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).

Results

Before surgery, 100 patients were included (84 F, age 38.4 ± 10.9 years, BMI 45.1 ± 6.02 kg/m2), of whom 73% reported GERD symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%; 69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP n = 15/36). The DeMeester score (normal <14.72) was significantly decreased after RYGBP (24.8 ± 13.7 before vs 5.8 ± 4.9 after; P < 0.001) but tended to increase after AGB (11.5 ± 5.1 before vs 51.7 ± 70.7 after; P = 0.09), with severe dyskinesia in 2 cases. Conclusion: GERD and LES incompetence are highly prevalent in morbidly obese patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of pH-metric data with occasional severe dyskinesia after AGB.

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Authors and Affiliations

  1. AP-HP, Hôpital Louis Mourier, University Paris VII, Service d’Hépato-Gastroentérologie, Colombes, France

    Mohamed Merrouche, Jean-Marc Sabaté, Pauline Jouet, Florence Harnois & Benoit Coffin

  2. AP-HP, Hôpital Louis Mourier, University Paris VII, Service de Chirurgie digestive, Colombes, France

    Stefano Scaringi & Simon Msika

  3. Service de Chirurgie Digestive, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP) Université Paris VII, 178 rue des Renouillers, 92701, Colombes CEDEX, France

    Simon Msika

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  1. Mohamed Merrouche
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  2. Jean-Marc Sabaté
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  3. Pauline Jouet
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  4. Florence Harnois
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  5. Stefano Scaringi
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  6. Benoit Coffin
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  7. Simon Msika
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Correspondence to Simon Msika.

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Merrouche, M., Sabaté, JM., Jouet, P. et al. Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery. OBES SURG 17, 894–900 (2007). https://doi.org/10.1007/s11695-007-9166-3

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  • DOI: https://doi.org/10.1007/s11695-007-9166-3

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