Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

Abstract

Background The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. Methods Consecutive morbidly obese (BMI ≥ 35 kg/m 2 ) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively.Results Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m 2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. Conclusions The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.

Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes

“…The pathophysiological mechanisms underlying this association are unknown as well but the mechanic and neurological consequences of obesity likely play a role. 34,[62][63][64] Hormonal factors are also likely in play; for example, higher levels of leptin in obese patients are correlated with esophageal dysmotility. 65 Interestingly in all included studies, these patients were asymptomatic despite their manometric diagnosis; this is likely secondary to the severe obesity-related alterations in sensory and autonomic pathways.…”

“…We found four studies reporting the specific prevalence of JE in morbidly obese patients or patients undergoing evaluation for bariatric surgery, [34][35][36][37] six in patients with systemic sclerosis [38][39][40][41][42][43] and four in postlung transplant patients [44][45][46][47] (Figure 3 of whether or not they were symptomatic. We found Kristo et al 34 to be an influential study and once excluded the prevalence of JE in obese patients was no longer statistically superior to the unselected general population (Table S2).…”

High‐resolution manometry in the upright position could improve the manometric evaluation of morbidly obese patients with esophagogastric junction outflow obstruction

“…The present study revealed that EGJOO was more prevalent in this study cohort than what was previously reported. 11 We evaluated the effects of body position on HRM results in morbidly obese patients with EGJOO. The major findings were that 75% of the patients with morbid obesity who were diagnosed as EGJOO by HRM, according to CC v3.0, were excluded from the diagnosis of EGJOO in the upright position.…”

“…The incidence of EGJOO was reported to be 2%- 16.5% in different cohorts of patients referred for esophageal highresolution manometry (HRM), [5][6][7][8][9][10] and this rate was 18.4% in patients with morbid obesity. 11 Previous studies showed that the integrated relaxation pressure (IRP) was significantly decreased when healthy volunteers were measured in the upright position rather than the supine position. 12,13 Triggs et al reported that upright IRP >12 mm Hg could help identify patients with clinically significant EGJOO.…”

Usefulness of Robinia pseudoacacia in the Treatment of Gastroesophageal Reflux Disease

“…9 The incidence of GERD was more in the BMI group of 26 to 28 kg/m 2 (n ¼ 10) which is in consonance with previous studies. [10][11][12] The prominent clinical symptoms were heartburn, regurgitation, water brash and nausea. As per GerdQ, 28 cases were moderate and two cases were severe.…”