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Performance of the Montreal Consensus in the Diagnosis of Gastroesophageal Reflux Disease in Morbidly Obese Patients

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Abstract

Background

Gastroesophageal reflux disease (GERD) has been increasingly recognized in patients with morbid obesity. A recent global evidence-based consensus on GERD has been proposed, but its performance in patients with morbid obesity is unknown. The aim of this study was to assess the performance of the Montreal Consensus in the diagnosis of GERD in morbidly obese patients.

Methods

Seventy-five consecutive morbidly obese patients underwent GERD symptoms assessment, upper gastrointestinal endoscopy, and ambulatory esophageal pH monitoring “off PPI”. The performance of the Montreal Consensus was determined by comparing two diagnostic algorithms: 1. a gold standard approach in which any GERD symptom and findings from both endoscopy and pH monitoring were taken into account, and 2. the approach with the Montreal Consensus, in which troublesome GERD symptoms and endoscopic findings were considered.

Results

GERD was found present in 57 patients by applying the gold standard approach. The Montreal Consensus identified 41 of these patients, whereas the remaining 34 patients were classified as “no GERD”. Of these, 16 (47%) showed reflux esophagitis and/or abnormal pH-metry. The Montreal Consensus had an accuracy of 78.7%, sensitivity of 72% (95% CI 59–82%), specificity of 100% (95% CI 82–100%) and negative predictive value of 47% (95% CI 37–57%).

Conclusions

In morbidly obese patients, the approach with the Montreal Consensus has high specificity and suboptimal sensitivity in the diagnosis of GERD. Its intermediate negative predictive value suggests that complementary investigation might be routine in these patients, particularly in those who do not present with troublesome GERD symptoms.

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References

  1. Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine. 2006;29:109–17.

    Article  PubMed  CAS  Google Scholar 

  2. Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.

    Article  PubMed  CAS  Google Scholar 

  3. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006;101:2128–38.

    Article  PubMed  Google Scholar 

  4. Sichieri R, Do NS, Coutinho W. The burden of hospitalization due to overweight and obesity in Brazil. Cad Saude Publica. 2007;23:1721–7.

    PubMed  Google Scholar 

  5. Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41.

    Article  PubMed  Google Scholar 

  6. El-Serag HB, Graham DY, Satia JA, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100:1243–50.

    Article  PubMed  Google Scholar 

  7. El-Serag HB, Kvapil P, Hacken-Bitar J, et al. Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol. 2005;100:2151–6.

    Article  PubMed  Google Scholar 

  8. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.

    PubMed  Google Scholar 

  9. Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–31.

    Article  PubMed  CAS  Google Scholar 

  10. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30.

    Article  PubMed  Google Scholar 

  11. Deitel M. The obesity epidemic. Obes Surg. 2006;16:377–8.

    Article  PubMed  Google Scholar 

  12. Cawley J, Prinz T, Beane S. Health insurance claims data as a means of assessing reduction in co-morbidities 6 months after bariatric surgery. Obes Surg. 2006;16:852–8.

    Article  PubMed  Google Scholar 

  13. Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.

    Article  PubMed  CAS  Google Scholar 

  14. Pandolfino JE, El-Serag HB, Zhang Q, et al. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130:639–49.

    Article  PubMed  Google Scholar 

  15. Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132:883–9.

    Article  PubMed  Google Scholar 

  16. 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;101:1900–20.

    Article  PubMed  Google Scholar 

  17. Fornari F, Gruber AC, Lopes AB, et al. Symptom’s questionnaire for gastroesophageal reflux disease. Arq Gastroenterol. 2004;41:263–7.

    Article  PubMed  Google Scholar 

  18. Velanovich V, Vallance SR, Gusz JR, et al. Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg. 1996;183:217–24.

    PubMed  CAS  Google Scholar 

  19. Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.

    Article  PubMed  Google Scholar 

  20. Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.

    Article  PubMed  CAS  Google Scholar 

  21. Ortiz V, Ponce M, Fernandez A, et al. Value of heartburn for diagnosing gastroesophageal reflux disease in severely obese patients. Obesity (Silver Spring). 2006;14:696–700.

    Article  Google Scholar 

  22. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  PubMed  CAS  Google Scholar 

  23. Wo JM, Castell DO. Exclusion of meal periods from ambulatory 24-hour pH monitoring may improve diagnosis of esophageal acid reflux. Dig Dis Sci. 1994;39:1601–7.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    PubMed  CAS  Google Scholar 

  25. Wiener GJ, Richter JE, Copper JB, et al. The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol. 1988;83:358–61.

    PubMed  CAS  Google Scholar 

  26. Abramson JH. WINPEPI (PEPI-for-Windows): computer programs for epidemiologists. Epidemiol Perspect Innov. 2004;1:6.

    Google Scholar 

  27. Bray GA. Obesity: a time bomb to be defused. Lancet. 1998;352:160–1.

    Article  PubMed  CAS  Google Scholar 

  28. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–78.

    Article  PubMed  CAS  Google Scholar 

  29. Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med. 1999;130:883–90.

    PubMed  CAS  Google Scholar 

  30. Linn S, Grunau PD. New patient-oriented summary measure of net total gain in certainty for dichotomous diagnostic tests. Epidemiol Perspect Innov. 2006;3:11.

    Article  PubMed  Google Scholar 

  31. Lee YC, Lin JT, Chiu HM, et al. Intraobserver and interobserver consistency for grading esophagitis with narrow-band imaging. Gastrointest Endosc. 2007;66:230–6.

    Article  Google Scholar 

  32. Johnson LF, DeMeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62:325–32.

    PubMed  CAS  Google Scholar 

  33. Aro P, Ronkainen J, Talley NJ, et al. Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study. Gut. 2005;54:1377–83.

    Article  PubMed  CAS  Google Scholar 

  34. Edelstein ZR, Farrow DC, Bronner MP, et al. Central adiposity and risk of Barrett’s esophagus. Gastroenterology. 2007;133:403–11.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  36. Corley DA, Kubo A, Zhao W. Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut. 2007;56:756–62.

    Article  PubMed  Google Scholar 

  37. Jansson C, Nordenstedt H, Johansson S, et al. Relation between gastroesophageal reflux symptoms and socioeconomic factors: a population-based study (the HUNT Study). Clin Gastroenterol Hepatol. 2007;5:1029–34.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. GASTROBESE, Instituto de Gastroenterologia e Colo-Proctologia de Passo Fundo, Rua Uruguai, 1555, 10 andar, 99010102, Passo Fundo, Rio Grande do Sul, Brazil

    Carlos Augusto Scussel Madalosso, Fernando Fornari & Carlos Antônio Madalosso

  2. ENDOPASSO, Passo Fundo, Rio Grande do Sul, Brazil

    Fernando Fornari

  3. Hospital São Vicente de Paulo, Passo Fundo, Rio Grande do Sul, Brazil

    Carlos Augusto Scussel Madalosso, Fernando Fornari & Carlos Antônio Madalosso

  4. Department of Statistics, Universidade Federal do Rio Grande do Sul, Port Alegre, Brazil

    Sidia M. Callegari-Jacques

  5. Post-Graduate Program in Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Carlos Augusto Scussel Madalosso & Richard Ricachenevsky Gurski

Authors
  1. Carlos Augusto Scussel Madalosso
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  2. Fernando Fornari
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  3. Sidia M. Callegari-Jacques
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  4. Carlos Antônio Madalosso
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  5. Richard Ricachenevsky Gurski
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Corresponding author

Correspondence to Fernando Fornari.

Additional information

Madalosso and Fornari contributed equally to the study.

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Madalosso, C.A.S., Fornari, F., Callegari-Jacques, S.M. et al. Performance of the Montreal Consensus in the Diagnosis of Gastroesophageal Reflux Disease in Morbidly Obese Patients. OBES SURG 18, 668–674 (2008). https://doi.org/10.1007/s11695-008-9462-6

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  • DOI: https://doi.org/10.1007/s11695-008-9462-6

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