LOS Function and Obesity: The Impact of Untreated Obesity, Weight Loss, and Chronic Gastric Balloon Distension

Abstract

Background/Aims: In obesity, many gastro-oesophageal reflux promoting factors are present. Weight reduction is advised to symptomatic overweight subjects. The aim of the present study was to investigate the influences of untreated obesity, weight loss, and chronic gastric balloon distension on the lower oesophageal sphincter (LOS) function. Methods: Patients entering a randomized, double-blind, sham-controlled study of balloon treatment, consisting of 4 months of either sham balloon or balloon treatment followed by 4 months of balloon treatment. Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks. Results: Before treatment, LOS dysfunction was present in 7 of 32 patients (21.9%). Increased upright and supine reflux was present in 8 patients (25%). Sham treatment resulted in a weight loss of 9.7% with improved LOS function (a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure) and in a significantly decreased upright reflux (acid reflux time decreasing from 8.0 to 5.5% and number of meal-related and postprandial reflux episodes decreasing from 49 to 32). These improved values deteriorated after 4 months of balloon placement, with significantly increasing total, upright, and supine reflux to 7.5, 7.6, and 6.7% of the time, respectively, with oesophageal lesions after an overall 17.8% weight loss. Four months of balloon treatment induced a similar weight loss (9.9%) with significantly increased supine reflux from 1.6 to 6.7% of the time. After a second 4-month balloon period and an overall 13.8% weight loss, LOS and reflux values returned towards baseline values. A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss. Conclusions: Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects. Weight loss ameliorated manometry and pH values, but subsequent balloon positioning tended to counteract these beneficial changes. In patients on balloon treatment from the start, adverse effects seemed to wear off with prolonged treatment.

Short- and Long-Term, 11–22 Years, Results after Laparoscopic Nissen Fundoplication in Obese versus Nonobese Patients

“…Therefore we agree with authors who affirm that for obese patients suffering from GERD weight loss in conjunction with antisecretory medications is first-line therapy [49]. Indeed, evidence supports the role of weight loss as a beneficial therapy for reflux symptoms [50, 51]. When medical efforts to lose weight fail, bariatric surgical procedure are considered (laparoscopic adjustable gastric band; vertical banded gastroplasty; Roux-en-y gastric bypass) [51, 52].…”

Lifestyle Intervention in Gastroesophageal Reflux Disease

“…37–39 In the first RCT, including 17 patients, 3 of 5 patients with pathological pH-measurements got normalized pH-measurements with weight loss of 31.3–44.0 kg after 4 months. 37 In the second RCT, 23 patients with a mean weight loss of 11.2 kg within 13 weeks had decreased time with esophageal pH <4 (from 5.60% to 3.72%, P <0.05).…”

“…38 These results were supported by the third RCT of 17 sham treated patients, where mean weight loss of 12.5 kg within 13 weeks improved time with upright pH <4 (from 8.0% to 5.5%, P <0.05). 39 …”

Randomized sham-controlled trials in endoscopy: a systematic review and meta-analysis of adverse events

“…Six studies reported adverse event data for subjects randomized to the sham arm, followed by cross-over to treatment 13–18 . In partial cross-over design studies, the estimated average pooled increased risk of developing a non-severe event after being randomized to the sham arm was risk ratio = 1.33 (95% CI, 1.14 – 1.56), p<0.001, I-squared = 6.74, Tau-squared = 0.003, compared with those randomized to the treatment group.…”