Journal article
Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass.
- Borbély Y Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. Electronic address: yves.borbely@insel.ch.
- Kröll D Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Nett PC Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Moreno P Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Tutuian R Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Lenglinger J Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- 2018-04-11
Published in:
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - 2018
Adults
Esophageal motility disorders
Esophageal pH
Functional disorder
Gastric acid
Gastroesophageal reflux disease
Hiatal hernia
Manometry
Roux-Y gastric bypass
Adult
Aged
Chronic Disease
Cross-Sectional Studies
Esophageal Motility Disorders
Female
Gastric Bypass
Gastroesophageal Reflux
Hernia, Hiatal
Humans
Intraoperative Complications
Magnetic Resonance Imaging
Male
Middle Aged
Multimodal Imaging
Obesity, Morbid
Retrospective Studies
Tomography, X-Ray Computed
Young Adult
English
BACKGROUND
Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%.
OBJECTIVE
To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors.
SETTING
University hospital, cross-sectional study.
METHODS
Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow.
RESULTS
Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8-12.6); median patient age was 36.5 years (19.1-67.2). Median body mass index was 30.3 kg/m2 (20.3-47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off-proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH<4) was found in 27 (61.4%), an increased number of reflux episodes (>53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%).
CONCLUSION
The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment.
Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%.
OBJECTIVE
To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors.
SETTING
University hospital, cross-sectional study.
METHODS
Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow.
RESULTS
Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8-12.6); median patient age was 36.5 years (19.1-67.2). Median body mass index was 30.3 kg/m2 (20.3-47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off-proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH<4) was found in 27 (61.4%), an increased number of reflux episodes (>53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%).
CONCLUSION
The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.soard.2018.02.028
- PMID 29631982
- Persistent URL
- https://sonar.ch/global/documents/178591
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