Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery

Ivan Kristo,Florian P Hennerbichler,Gerd Jomrich,Mario Fischer,Sebastian F Schoppmann,Felix B Langer,Daniel M Felsenreich,Gerhard Prager,Matthias Paireder

doi:10.1007/s11695-020-04959-6

Ivan Kristo, Florian P Hennerbichler + Show 7 more

Open Access

https://doi.org/10.1007/s11695-020-04959-6

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Abstract

PurposeLong-term follow-up after sleeve gastrectomy (SG) revealed a high incidence of gastroesophageal reflux disease (GERD) frequently caused by preoperative silent pathologic reflux. We aimed to evaluate prevalence and phenotypes of GERD in asymptomatic patients with morbid obesity prior to metabolic surgery according to modern objective testing.Material and MethodsProspective collection of data including consecutive patients with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) prior to metabolic surgery was applied for this study between 2014 and 2019. Patients underwent clinical examinations, endoscopy, pH metry, and high-resolution manometry and were analyzed according to the Lyon consensus.ResultsOf 1379 patients undergoing metabolic surgery, 177 (12.8%, females = 105) asymptomatic individuals with a median age of 42.6 (33.8; 51.6) years and a median BMI of 44.6 (41.3; 50.8) kg/m2 completed objective testing and were included during the study period. GERD was diagnosed in 55 (31.1%), whereas criteria of borderline GERD were met in another 78 (44.1%). GERD was mediated by a structural defective lower esophageal sphincter (p = 0.004) and highlighted by acidic (p = 0.004) and non-acidic (p = 0.022) reflux episodes. Esophageal motility disorders were diagnosed in 35.6% (n = 63) of individuals with a novel hypercontractile disorder found in 7.9% (n = 14) of patients.ConclusionGERD affects a majority of asymptomatic patients with morbid obesity prior to primary bariatric surgery. Future longitudinal trials will have to reveal the clinical significance of esophageal motility disorders in patients with morbid obesity.

Highlights

Adverse life style behavior and obesity represent demanding challenges in modern medicine
Long-term follow-up after sleeve gastrectomy (SG) revealed a high incidence of gastroesophageal reflux disease (GERD) and Barrett’s esophagus, a premalignant condition caused by reflux of gastric contents [5]
Concomitant outflow obstruction was noted in 64.3% (n = 9) of patients with Jackhammer esophagus (JE) and 60% (n = 6) of individuals with distal esophageal spasm. This is the first study investigating a large sample of asymptomatic patients with morbid obesity prior to primary metabolic surgery following a modern concept of GERD

Summary

Introduction

Adverse life style behavior and obesity represent demanding challenges in modern medicine. As a consequence, related chronic diseases will affect general health status and increase the socioeconomic burden [2]. As far as weight loss and remission rates of type II diabetes and metabolic syndrome are concerned, metabolic surgery is more effective when compared with non-surgical options and was implemented as an effective strategy fighting obesity [3]. Long-term follow-up after SG revealed a high incidence of gastroesophageal reflux disease (GERD) and Barrett’s esophagus, a premalignant condition caused by reflux of gastric contents [5]. Undetected preoperative silent GERD may attribute to these outcomes [6]. SG is controversial in patients with preexisting pathologic reflux

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