GERD and LES incompetence are highly prevalent in morbidly obese patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of pH-metric data with occasional severe dyskinesia after AGB.

The effects of renutrition on gastric emptying and upper gastrointestinal symptoms were evaluated in 14 anorexia nervosa patients before and after weight gain. A double-isotope technique was used to measure gastric emptying of both the solid and the liquid phases of the meal. Upper gastrointestinal symptoms were frequent before renutrition, occurring in 78% of the patients. Among these symptoms, nausea, vomiting and gastric fullness were correlated well with slowing in gastric emptying of both solid and liquid phases of the meal, which was demonstrated, respectively, in 10 (71%) and nine (64%) of the 14 patients. For the 11 patients who subsequently gained body weight, we observed, without any pharmacological treatment, an improvement of gastric emptying of both solid and liquid phases of the meal in eight (73%) and seven (64%) patients, respectively. Gastric emptying was unchanged in the three other patients who gained very little weight during the time of the study. As gastric emptying improved, so did nausea, vomiting, and gastric fullness. In three patients who had initially gained weight, nausea and gastric fullness recurred, associated again in all cases with a delay in gastric emptying. In conclusion, in anorexia nervosa, delayed gastric emptying, which is a frequent feature and which is well correlated with some of the upper digestive complaints, can return to normal without any pharmacological treatment. In this improvement, psychological assistance may play a role, together with the correction of the malnutrition.

The relationship between asthma and gastro-oesophageal reflux (GER) is controversial. In an allergy department, GER prevalence was evaluated in asthmatics, with a view to judging the potential influence of GER on asthma.One hundred and five asthmatics were recruited and co-investigated for GER and lung function. Descriptive analysis was performed, patients with (GER+) and without (GER-) GER were then compared, and finally, stepwise regression analysis was used. GER prevalence was 32%.Lung parameters did not differ between GER+ and GER-patients. When restricting analysis to GER+ patients, bronchial reactivity was closely correlated to the number of reflux episodes (NRE) (r=0.983; p=0.001). When comparing patients with more than 15 reflux episodes·day -1 (n=50), with those having less (n=43), no differences were found in lung function and GER parameters. However, there was a positive correlation between the provocative dose of methacholine causing forced expiration volume to fall 20% from the baseline and NRE in patients with NRE>15 (r=0.561; p=0.05).In conclusion, gastro-oesophageal reflux was observed in a third of the asthma patients studied. These data do not support a firm aetiological relationship between gastro-oesophageal reflux and asthma, but do suggest an association between the number of reflux episodes and bronchial hyperresponsiveness. Eur Respir J 1997; 10: 2255-2259 Asthma is a bronchial disease characterized by an inflammatory process [1]. Gastro-oesophageal reflux (GER) has been suspected as a causal factor, but the relationship between GER and asthma remains controversial.The physiopathological mechanisms involved in this potential relationship are still hypothetical [2-4], although two main mechanisms are usually accepted, reflex [5][6][7] or acid inhalation [8][9][10]. A possible relationship between the severity of GER and that of asthma has not been investigated previously.GER prevalence is not precisely known in asthmatics; it has been estimated at levels of 20 to even 80% [11]. Finally, it is not known which groups of asthma patients in particular should be investigated for GER.This controversy induced us to conduct a prospective assessment of GER prevalence in a population of 105 consecutively admitted asthmatic out-patients and to search for a relationship between the development of asthma and that of GER. Materials and methods PatientsOne hundred and five consecutively admitted asthmatic out-patients were investigated. Asthma was diagnosed according to international consensus guidelines [12]. Besides clinical data, airway obstruction was measured and its reversibility was defined as a 20% improvement in forced expiratory volume in one second (FEV1) after bronchodilator administration, or a 20% decrease in FEV1 after methacholine bronchoprovocation. FEV1 was measured with a pocket-sized spirometer (Spirobank®; Isotec, Saint-Quentin, France). Results were expressed in real values and as the percentage of standard values for age, gender and height [13]. Bronchoprovocation tests w...