Jennifer A Minneman, Judy Chen, Annie P Ehlers, Edwin Nieblas-Bedolla, Malika Hale, Michael Cruz, Andrew Wright, Saurabh Khandelwal. UW
Background: Gastroesophageal reflux disease (GERD) and esophageal dysmotility symptoms after laparoscopic sleeve gastrectomy (LSG) pose challenging clinical problems. Few centers assess for GERD or motility disorders prior to performing LSG. Prior studies demonstrate a high prevalence of esophageal motility abnormalities in morbidly obese patients (21-61%), but few of these studies were performed with high-resolution manometry (HRM) and most do not include patient symptomatology. We hypothesize that there is a high prevalence of undiagnosed motility disorders and GERD in a morbidly obese patient population being evaluated for sleeve gastrectomy.
Methods: We performed HRM and 24-hour pH testing in 122 consecutive patients considering sleeve gastrectomy in 2017. We retrospectively analyzed prospectively-collected data from the electronic medical record and symptom surveys filled out at the time of their studies. Motility disorders were defined based on the Chicago classification v3.0. GERD was defined by an abnormal DeMeester score (>14.7) on 24-hour pH manometry.
Results: Of all patients studied, 44/122 (36%) had a motility disorder. The most common condition was ineffective esophageal motility (65.9%). Other diagnoses included esophagogastric junction outflow obstruction (27.2%), jackhammer (hypercontractile) esophagus (4.5%) and diffuse esophageal spasm (2.3%). Patients with abnormal motility had a higher median BMI than those with normal motility (49 versus 45, p=0.01). Symptom survey data was available for 109/122 patients, including 82% of patients with motility disorders and 86% of patients with normal motility. Reported dysphagia was low regardless of whether the patient had a motility disorder (13.9%) or not (17.9%). Absence of dysmotility symptoms (dysphagia, chest pain, regurgitation) was similar for patients with motility disorders compared to those with normal motility (47.5% versus 50.7%, p=0.87). Abnormal DeMeester scores were seen in 38/122 (31.1%) patients, with 70% of these patients reporting heartburn. Additionally, heartburn was not limited to patients with abnormal DeMeester scores – 45% of patients with normal DeMeester scores also complained of heartburn (p=0.04).
Conclusions: There is a high prevalence of both motility disorders and GERD in patients being considered for LSG. Dysphagia and heartburn are unreliable in identifying abnormal esophageal motility and GERD in morbidly obese patients. When deciding whether to offer patients LSG, accurately diagnosing abnormal motility and pathologic GERD using HRM and pH testing may lead to improved preoperative counseling and patient selection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93478
Program Number: S135
Presentation Session: Bariatric V – GERD and Esophageal Physiology
Presentation Type: Podium