Factors Associated to Abnormal Distal Esophageal Exposure to Acid and Esophagitis in Individuals Seeking Bariatric Surgery.
Surg Obes Relat Dis
; 15(5): 710-716, 2019 May.
Article
en En
| MEDLINE
| ID: mdl-31010734
ABSTRACT
BACKGROUND:
Gastroesophageal reflux disease (GERD) impacts choice and outcomes of bariatric surgery. However, GERD diagnosis based solely on symptoms yields inaccurate results.OBJECTIVE:
To determine the factors associated with a positive 24h pH-monitoring (pH-test) or esophagitis in patients with severe obesity seeking bariatric surgery.SETTING:
Private practice.METHODS:
93 patients with severe obesity underwent prospective evaluation for GERD symptoms, body composition, upper gastrointestinal endoscopy, esophageal manometry and pH-test. Correlation analyses were performed.RESULTS:
50 patients (53.8%) had GERD symptoms, 49 (52.7%) had esophagitis and 33 (35.5%) had a positive pH-test. Among patients with GERD symptoms, 18% had normal pH-test and no esophagitis, while 34.9% of patients without GERD symptoms had positive pH-test, esophagitis or both. Factors independently associated with positive pH-test were esophagitis (PR3.08, 95%CI 1.4-6.9, Pâ¯=â¯0.006) and defective lower esophageal sphincter (PR1.88, 95%CI 1.09-3.21, Pâ¯=â¯0.02). Factors independently associated with esophagitis were hiatal hernia (PR 2.46; 95%CI 1.6-3.7, P<0.001), GERD symptoms (PR2.09; 95%CI 1.3-3.4, Pâ¯=â¯0.003) and positive pH-test (PR1.82; 95%CI 1.2-2.7, Pâ¯=â¯0.003). The combined presence of GERD symptoms and esophagitis had a low positive predictive value for a positive pH-test (57%). On the other hand, the absence of both GERD symptoms and esophagitis had a 90% predictive value for a negative pH-test.CONCLUSIONS:
Investigation for GERD before bariatric surgery should consist of routine upper endoscopy and GERD symptom evaluation in all patients. Patients with GERD symptoms and no esophagitis may need a pH-test for GERD diagnosis. Prospective studies are needed to understand significance of GERD diagnosis prior to bariatric surgery.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Obesidad Mórbida
/
Reflujo Gastroesofágico
/
Esofagitis
/
Cirugía Bariátrica
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
País/Región como asunto:
America do sul
/
Brasil
Idioma:
En
Revista:
Surg Obes Relat Dis
Asunto de la revista:
METABOLISMO
Año:
2019
Tipo del documento:
Article