Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery.
PURPOSE
Long-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 METHODS
Prospective 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.


RESULTS
Of 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.


CONCLUSION
GERD 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.
['Kristo|Ivan|I|', 'Paireder|Matthias|M|', 'Jomrich|Gerd|G|', 'Felsenreich|Daniel M|DM|', 'Fischer|Mario|M|', 'Hennerbichler|Florian P|FP|', 'Langer|Felix B|FB|', 'Prager|Gerhard|G|', 'Schoppmann|Sebastian F|SF|http://orcid.org/0000-0002-1725-7086']
D050110:Bariatric Surgery D005260:Female D005743:Gastrectomy D005764:Gastroesophageal Reflux D006801:Humans D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D011183:Postoperative Complications D011446:Prospective Studies
Morbid obesity GERD Asymptomatic pH metry Manometry Lyon