Skip to main content

Advertisement

SpringerLink
Log in

Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery. A Prospective Study

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

Abstract

Background

Before bariatric surgery, the necessity of routine upper gastrointestinal endoscopy is controversial, and guidelines recommend endoscopy in symptomatic cases. However, impaired visceral sensation occurring in obese patients may be misleading. The purpose of the study is to evaluate prospectively the prevalence of gastrointestinal symptoms, endoscopic findings, and the relation between symptoms and endoscopic findings in obese patients before surgery.

Materials and Methods

One hundred forty-two consecutive patients candidate to primary bariatric surgery filled out the validated Rome III symptomatic questionnaire and performed endoscopy.

Results

With a median age of 41 years and BMI of 44 Kg/m2, 83 % were females. Symptoms were referred by 43 % of patients: gastroesophageal reflux disease (GERD) (27.9 %) and dyspepsia (24.6 %), subdivided in postprandial distress (PDS) (66.7 %) and epigastric pain (33.3 %) syndromes. Of GERD patients, 19.7 % presented concomitantly PDS. Belching was present in 8.2 % and nausea and/or vomiting in 1.6 % of patients. At endoscopy, one or more lesions were present in 47.1 % of the patients: erosive esophagitis (5.6 %), hiatal hernia (23.2 %), gastroduodenal erosions (6.3 %), and peptic ulcers (3.5 %). At histology, 24 % of patients have Helicobacter pylori infection, and its prevalence in gastroduodenal erosions and ulcers was 22.2 and 60 %, respectively. Surprisingly, in patients with peptic lesions H. pylori-negative, no chronic use of NSAIDs was reported. Analyzing the coexistence of symptoms and lesions, these resulted equally distributed beyond the presence of symptoms, being present in 44.2 and 49.4 % of symptomatic and asymptomatic patients, respectively.

Conclusions

The presence of symptoms cannot be considered as a valuable guide to indicate endoscopy since the majority of endoscopic lesions were asymptomatic and not H. pylori-related.

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. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;Suppl 1:S1–27. PMID: 23529939.

    Article  Google Scholar 

  2. Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres AJ, Weiner R, et al. European Association for the Study of Obesity; International Federation for the Surgery of Obesity - European Chapter. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6(5):449–68. PMID: 24135948.

    Article  PubMed  Google Scholar 

  3. Korenkov M, Sauerland S, Shah S, Junginger T. Is routine preoperative upper endoscopy in gastric banding patients really necessary? Obes Surg. 2006;16(1):45–7. PMID: 16417757.

    Article  PubMed  Google Scholar 

  4. Sharaf RN, Weinshel EH, Bini EJ, Rosenberg J, Sherman A, Ren CJ. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg. 2004;14(10):1367–72. PMID: 15603653.

    Article  PubMed  Google Scholar 

  5. Azagury D, Dumonceau JM, Morel P, Chassot G, Huber O. Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory? Obes Surg. 2006;16(10):1304–11. PMID: 17059738.

    Article  CAS  PubMed  Google Scholar 

  6. Küper MA, Kratt T, Kramer KM, Zdichavsky M, Schneider JH, Glatzle J, et al. Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery. Surg Endosc. 2010;24(8):1996–2001. PMID: 20135170.

    Article  PubMed  Google Scholar 

  7. Koppman JS, Poggi L, Szomstein S, Ukleja A, Botoman A, Rosenthal R. Esophageal motility disorders in the morbidly obese population. Surg Endosc. 2007;21(5):761–4. PMID: 17285388.

    Article  CAS  PubMed  Google Scholar 

  8. Côté-Daigneault J, Leclerc P, Joubert J, Bouin M. High prevalence of esophageal dysmotility in asymptomatic obese patients. Can J Gastroenterol Hepatol. 2014;28(6):311–4. PMID: 24945185.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Greenstein RJ, Nissan A, Jaffin B. Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg. 1998;8(2):199–206. PMID: 9730394.

    Article  CAS  PubMed  Google Scholar 

  10. Ganesh R, Rao AD, Leese T, Baladas HG. Laparoscopic adjustable gastric banding in a patient with an incidental para-hiatal hernia. Obes Surg. 2006;16(1):98–101. PMID: 16417766.

    Article  Google Scholar 

  11. Chang CG, Perez E. Case reports—resolution of Barrett’s disease and esophageal epithelial atypia after gastric bypass and LAP-BAND. Obes Surg. 2009;19(11):1597–8. PMID: 19756886.

    Article  PubMed  Google Scholar 

  12. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130(5):1466–79. PMID: 16678560.

    Article  PubMed  Google Scholar 

  13. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20. PMID: 16928254.

    Article  PubMed  Google Scholar 

  14. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–80. PMID: 10403727.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;Suppl 1:S14–80. PMID: 24357209.

    Article  Google Scholar 

  16. Loewen M, Giovanni J, Barba C. Screening endoscopy before bariatric surgery: a series of 448 patients. Surg Obes Relat Dis. 2008;4(6):709–12. PMID: 18514584.

    Article  PubMed  Google Scholar 

  17. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19. PMID: 22248433.

  18. Li JF, Lai DD, Lin ZH, Jiang TY, Zhang AM, Dai JF. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24(1):1–11. PMID: 24487151.

  19. Humphreys LM, Meredith H, Morgan J, Norton S. Detection of asymptomatic adenocarcinoma at endoscopy prior to gastric banding justifies routine endoscopy. Obes Surg. 2012;22(4):594–6. PMID:21887608.

    Article  PubMed  Google Scholar 

  20. Zeni TM, Frantzides CT, Mahr C, Denham EW, Meiselman M, Goldberg MJ, et al. Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass. Obes Surg. 2006;16(2):142–6. PMID: 16469214.

    Article  PubMed  Google Scholar 

  21. de Moura Almeida A, Cotrim HP, Santos AS, Bitencourt AG, Barbosa DB, Lobo AP, et al. Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary? Surg Obes Relat Dis. 2008;4(2):144–9. PMID: 18294926.

  22. Csendes A, Burgos AM, Smok G, Beltran M. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg. 2007;17(1):28–34. PMID: 17355765.

    Article  PubMed  Google Scholar 

  23. Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg. 2013;23(6):736–9. PMID: 23585025.

    Article  CAS  PubMed  Google Scholar 

  24. Dietz J, Ulbrich-Kulcynski JM, Souto KE, Meinhardt NG. Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients. Arq Gastroenterol. 2012;49(1):52–5. PMID: 22481686.

    PubMed  Google Scholar 

  25. Long E, Beales IL. The role of obesity in oesophageal cancer development. Ther Adv Gastroenterol. 2014;7(6):247–68. PMID: 25364384.

    Article  CAS  Google Scholar 

  26. Carabotti M, Severi C, Leonetti F, De Angelis F, Iorio O, Corazziari E, et al. Upper gastrointestinal symptoms in obese patients and their outcomes after bariatric surgery. Expert Rev Gastroenterol Hepatol. 2013;7(2):115–26. PMID: 23363261.

    Article  CAS  PubMed  Google Scholar 

  27. Santonicola A, Angrisani L, Ciacci C, Iovino P. Prevalence of functional gastrointestinal disorders according to Rome III criteria in Italian morbidly obese patients. Sci World J. 2013;2013:532503. PMID: 24302861.

    Article  Google Scholar 

  28. Fysekidis M, Bouchoucha M, Bihan H, Reach G, Benamouzig R, Catheline JM. Prevalence and co-occurrence of upper and lower functional gastrointestinal symptoms in patients eligible for bariatric surgery. Obes Surg. 2012;22(3):403–10. PMID: 21503810.

    Article  PubMed  Google Scholar 

  29. Tilg H, Moschen AR. Visceral adipose tissue attacks beyond the liver: esophagogastric junction as a new target. Gastroenterology. 2010;139(6):1823–6. PMID: 20977875.

    Article  PubMed  Google Scholar 

  30. Carabotti M, D'Ercole C, Iossa A, Corazziari E, Silecchia G, Severi C. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol. 2014;20(3):647–53. PMID: 24574738.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank Mariana Ridolfi for her helpful collaboration in collection of data. Grant was received from the University of Rome Sapienza (2013).

Conflict of Interest

The authors declare that they have no competing interests.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

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.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Medical Specialties, University of Rome “Sapienza”, viale del Policlinico 155, 00161, Rome, Italy

    Marilia Carabotti, Annunziata Scirocco & Carola Severi

  2. Department of Medical Surgical Sciences and Biotechnology, University of Rome “Sapienza”, Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy

    Marcello Avallone, Fabrizio Cereatti & Gianfranco Silecchia

  3. Department P. Stefanini, University of Rome “Sapienza”, viale del Policlinico 155, 00161, Rome, Italy

    Alessandro Paganini

  4. AUSL Viterbo Ospedale Andosilla, via Ferretti 169, 01033, Civita Castellana, VT, Italy

    Francesco Greco

Authors
  1. Marilia Carabotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcello Avallone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabrizio Cereatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Paganini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annunziata Scirocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carola Severi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gianfranco Silecchia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marilia Carabotti.

Additional information

G. Silecchia and C. Severi are the principal investigators.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carabotti, M., Avallone, M., Cereatti, F. et al. Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery. A Prospective Study. OBES SURG 26, 1075–1080 (2016). https://doi.org/10.1007/s11695-015-1861-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1861-x

Keywords

Search

Navigation