Obesity and Gastroesophageal Reflux Disease: Preoperative Evaluation of the Esophageal Function

Rudolf Buxhoeveden, MD, Veronica Gorodner, MD, Gaston Clemente, MD, Laura Sole, MD, Luis Caro, MD, Alejandro Grigaites, MD. Programa de Unidades Bariatricas.

Introduction: multiple studies indicate that there is a strong correlation between obesity and gastroesophageal reflux disease (GERD). Published data reporting the influence of laparoscopic sleeve gastrectomy (LSG) on GERD are controversial. It has been said that LSG could induce de novo GERD or worsen it due to disruption of the antireflux barrier. Therefore, Roux-en-Y gastric bypass (RYGB) would be the best treatment option for GERD in the obese patient. Our goal was: 1) to show esophageal manometry (EM) and 24 hs pH monitoring results in a selected population; 2) to compare results sorting the patients according to their BMI; 3) to evaluate change in surgical technique according to the esophageal function tests.

Methods and Procedures: retrospective review of prospectively collected data. Esophageal function test (EFT’s) were performed preoperatively in all patients scheduled for LSG. Patients were divided according to their initial BMI. Group A (non morbid obese patients): <40 kg/m², and Group B (morbid obese patients): ≥40 kg/m². Demographics and EFT’s results were analyzed.

Results: 92 patients underwent EFT’s; results for 24 hs pH monitoring were available in 81 patients; 78% were female, mean age 41±9 years. Group A: BMI 37±2 kg/m²; Group B: BMI 42±2 kg/m². Results were expressed as mean ± SD.


Manometry Total (92 pts)
Group A (21 pts)
Group B (71 pts) p
LES length (cm) 3±1 3±1 3±1 NS
LESP (mmHg) 17±6 17±7 17±6 NS
LES diagnosis        
  • Abnormal
9 (10%) 2 (10%) 7 (10%) NS
Esophageal Body        
  • Abnormal
13 (14%) 2 (2%) 11 (15%) NS
DEA (mmHg) 73±25 76±24 72±26 NS
pH monitoring Total (81 pts) Group A (19pts) Group B (62 pts) p
% time pH <4 3.6±3.4 3.8±3.5 3.5±3.4 NS
De Meester 14±13.2 14.9±12.3 13.7±13.5 NS
#pts w/ GERD 25 (31%) 8 (42%) 17 (27%) NS

LES:lower esophageal sphincter; LESP: LES pressure esfínter esofágico inferior; DEA: distal esophageal amplitud

EFT’s results modified our decision on the surgical technique in 9 (11%) patients, choosing RYGB instead of LSG; 18 (20%) patients still preferred LSG, even though they were explained they would probably need long term PPI’s therapy

Conclusions: our study showed that: 1) there was no statistically significant difference in EFT’s results when comparing Group A vs. B; 2) surgical technique was modified according to EFT’s results in 11% of patients, and it would have been modified in other 20% of them. Future studies based on postoperative EFT’s results would provide objective data to assess the real influence of LSG on GERD.

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