Esophageal motility in pathologically obese patients: A multidisciplinary approach

Abstract

In the last fifty years the standard of living in the industrialized countries led to a remarkable increase of the incidence of obesity. It is well known in the literature that this pathologic condition is associated with alteration of gastric emptying and Autonomic Nervous System (ANS) dysfunction. AIM: evaluate esophageal motility and ANS function in pathologically obese patients. METHODS: from January to June 1997 we evaluated all the obese patients referred to our institution for baryatric surgery. Exclusion criteria were: diabetes, hypertension, cardiac arhythmia, syncope, peripheral neuropathies, current or recently therapy with steroids, beta-blockers, beta-agonists, psychotrope drugs, epilepsy and Raynaud phenomenon. We enrolled in our study 22 patients (3 M and 19 F, mean age 36, range 25-57 years, Body Mass Index 45.72 ± 7.48) and 22 age and sex matched controls. Esophageal motility was evaluated by stationary manometry, scintigraphyc transit with a Tc 99 m marked bolus. Cardiovascular tests for the evaluation of ANS were: Valsalva Ratio, Deep Breathing, Sustained Handgrip and spectral analysis of the variability of the R-R interval. RESULTS: Compared to controls 54.5% of patients showed a reduction of esophageal pressure values at manometry, 13.7% were borderline and 31.8% were normal. Scintigraphyc esophageal transit was pathologically slow in 63% of patients, borderline in 9% and normal in 27%. Tests for ANS were normal in all patients whereas the spectral analysis of the variability of R-R interval showed an increase of the parasympathetic component both in lying and standing position compared to controls. CONCLUSIONS: Our data show that in obese patients there is an alteration of esophageal motility and ANS function even if they may appear to be in contrast. In our opinion these results suggest that esophageal motility is not regulated only by dichotomic system but is the result of a more complex nervous integration.