Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery
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ORIGINAL CONTRIBUTIONS
Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery Ivan Kristo 1 & Matthias Paireder 1 & Gerd Jomrich 1 & Daniel M. Felsenreich 2 & Mario Fischer 1 & Florian P. Hennerbichler 1 & Felix B. Langer 2 & Gerhard Prager 2 & Sebastian F. Schoppmann 1 Received: 19 April 2020 / Revised: 27 August 2020 / Accepted: 4 September 2020 # The Author(s) 2020
Abstract 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. Keywords GERD . Morbid obesity . Asymptomatic . Lyon . Manometry . pH metry
Introduction Adverse life style behavior and obesity represent demanding challenges in modern medicine. By 2030, 1 in 2 adults is projected to have obesity, whereas 1 in 4 adults will even have
severe obesity, which is likely to become the most common body mass index (BMI) category among women [1]. As a consequence, related chronic diseases will affect general health status and increase the socioeconomic burden [2].
* Sebastian F. Schoppmann [email protected]
Florian P. Hennerbichler [email protected]
Ivan Kristo [email protected]
Felix B. Langer [email protected]
Matthias Paireder [email protected]
Gerhard Prager [email protected]
Gerd Jomrich [email protected] 1
Department of Surgery, Upper GI Research & Service, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Aus
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