Gastroesophageal reflux disease in patients with morbid obesity

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.1.219086

Keywords:

morbid obesity, gastroesophageal reflux disease, esophagogastric junction, lower esophageal sphincter

Abstract

Aim. To study the prevalence and manifestations of gastroesophageal reflux disease (GERD) in patients with morbid obesity based on endoscopic, X-ray findings and the function of the lower esophageal sphincter.

Materials and methods. The study involved 98 obese patients with a mean body mass index (BMI) of 55.6 ± 10.3 kg/m2. Of these, 30 were men (34.48 %) and 68 were women (65.52 %) aged 18–64 years, mean age – 42.3 ± 8.5. All the patients subsequently underwent fibroesophagogastroduodenoscopy, esophagomanometry, 24-hour esophageal pH monitoring, X-ray examination and bariatric surgery. The presence and severity of pathological gastroesophageal reflux were assessed using esophageal pH monitoring data based on the DeMeester score. In addition, the lower esophageal sphincter function was assessed, the number of refluxes and the duration of the longest reflux episode were calculated according to the data of esophagomanometry and 24-hour esophageal pH monitoring. Statistical data processing was carried out using the StatPlus 2007 software package.

Results. In this paper, we studied the prevalence and manifestations of gastroesophageal reflux in 98 obese patients. The mean BMI was 55.6 ± 10.3 kg/m2, the maximum was 72 kg/m2. GERD was diagnosed in 37 (37.76 %) patients, including 8 (8.16 %) patients with a hiatal hernia. The erosive form prevailed in the GERD pattern – in 24 (24.48 %) patients. In 32 (32.65 %) examined patients, pathological reflux was diagnosed during the daytime, especially after eating.

Conclusions. The study results indicate that 37.76 % of obese patients are diagnosed with GERD arising from anatomical features and function of the gastroesophageal junction with the predominance of erosive forms of GERD. The state of the gastroesophageal junction in obese patients should be considered when choosing the optimal bariatric or metabolic surgery.

Author Biographies

A. S. Lavryk, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, PhD, DSc, Professor, Chief Researcher of the Department of Thoracic and Abdominal Surgery, member of the Council of Ukraine of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

V. V. Kucheruk, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, PhD, Senior Researcher of the Department of Thoracic and Abdominal Surgery

O. P. Dmytrenko, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, PhD, Junior Researcher of the Department of Thoracic and Abdominal Surgery

I. S. Tereshkevych, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, PhD, Senior Researcher, endoscopist of the Department of Interventional Endoscopy

H. M. Lytvynchuk, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, general surgeon

Yu. M. Razdobudko, SI “Shalimov National Institute of Surgery and Transplantation” NAMS of Ukraine, Kyiv

MD, radiologist, Department of X-Ray, CT, MRI Diagnostics

References

Vakil, N., van Zanten, S. V., Kahrilas, P., Dent, J., Jones, R., & Global Consensus Group. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. The American Journal of Gastroenterology, 101(8), 1900-1943. https://doi.org/10.1111/j.1572-0241.2006.00630.x

Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology, 108(3), 308-329. https://doi.org/10.1038/ajg.2012.444

Dent, J., Becher, A., Sung, J., Zou, D., Agréus, L., & Bazzoli, F. (2012). Systematic Review: Patterns of Reflux-Induced Symptoms and Esophageal Endoscopic Findings in Large-Scale Surveys. Clinical Gastroenterology and Hepatology, 10(8), 863-873.e3. https://doi.org/10.1016/j.cgh.2012.02.028

Gyawali, C. P., Roman, S., Bredenoord, A. J., Fox, M., Keller, J., Pandolfino, J. E., Sifrim, D., Tatum, R., Yadlapati, R., Savarino, E., & International GERD Consensus Working Group. (2017). Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group. Neurogastroenterology & Motility, 29(12), Article e13104. https://doi.org/10.1111/nmo.13104

Gyawali, C. P., Kahrilas, P. J., Savarino, E., Zerbib, F., Mion, F., Smout, A., Vaezi, M., Sifrim, D., Fox, M. R., Vela, M. F., Tutuian, R., Tack, J., Bredenoord, A. J., Pandolfino, J., & Roman, S. (2018). Modern diagnosis of GERD: the Lyon Consensus. Gut, 67(7), 1351-1362. https://doi.org/10.1136/gutjnl-2017-314722

Doulami, G., Triantafyllou, S., Natoudi, M., Albanopoulos, K., Leandros, E., Zografos, G., & Theodorou, D. (2015). GERD-Related Questionnaires and Obese Population: Can They Really Reflect the Severity of the Disease and the Impact of GERD on Quality of Patients' Life? Obesity Surgery, 25(10), 1882-1885. https://doi.org/10.1007/s11695-015-1614-x

Wakeam, E., Wee, J., Lebenthal, A., Ali, S. O., Gilbert, R. J., & Bueno, R. (2014). Does BMI Predict Recurrence or Complications After Reoperative Reflux Surgery? Review of a Single Center’s Experience and a Comparison of Outcomes. Journal of Gastrointestinal Surgery, 18(11), 1965-1973. https://doi.org/10.1007/s11605-014-2656-4

Jacobson, B. C., Somers, S. C., Fuchs, C. S., Kelly, C. P., & Camargo, C. A., Jr. (2006). Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women. The New England Journal of Medicine, 354(22), 2340-2348. https://doi.org/10.1056/NEJMoa054391

Hampel, H., Abraham, N. S., & El-Serag, H. B. (2005). Meta-Analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications. Annals of Internal Medicine, 143(3), 199-211. https://doi.org/10.7326/0003-4819-143-3-200508020-00006

Ayazi, S., Hagen, J. A., Chan, L. S., DeMeester, S. R., Lin, M. W., Ayazi, A., Leers, J. M., Oezcelik, A., Banki, F., Lipham, J. C., DeMeester, T. R., & Crookes, P. F. (2009). Obesity and Gastroesophageal Reflux: Quantifying the Association Between Body Mass Index, Esophageal Acid Exposure, and Lower Esophageal Sphincter Status in a Large Series of Patients with Reflux Symptoms. Journal of Gastrointestinal Surgery, 13(8), 1440-1447. https://doi.org/10.1007/s11605-009-0930-7

Stenard, F., & Iannelli, A. (2015). Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World Journal of Gastroenterology, 21(36), 10348-10357. https://doi.org/10.3748/wjg.v21.i36.10348

Kendall, B. J., Macdonald, G. A., Hayward, N. K., Prins, J. B., Brown, I., Walker, N., Pandeya, N., Green, A. C., Webb, P. M., Whiteman, D. C., & Study of Digestive Health. (2008). Leptin and the risk of Barrett's oesophagus. Gut, 57(4), 448-454. https://doi.org/10.1136/gut.2007.131243

Ierardi, E., Rosania, R., Zotti, M., Principe, S., Laonigro, G., Giorgio, F., de Francesco, V., & Panella, C. (2010). Metabolic syndrome and gastro-esophageal reflux: A link towards a growing interest in developed countries. World Journal of Gastrointestinal Pathophysiology, 1(3), 91-96. https://doi.org/10.4291/wjgp.v1.i3.91

Pallati, P. K., Shaligram, A., Shostrom, V. K., Oleynikov, D., McBride, C. L., & Goede, M. R. (2014). Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surgery for Obesity and Related Diseases, 10(3), 502-507. https://doi.org/10.1016/j.soard.2013.07.018

Matar, R., Maselli, D., Vargas, E., Veeravich, J., Bazerbachi, F., Beran, A., Storm, A. C., Kellogg, T., & Abu Dayyeh, B. K. (2020). Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database. Obesity Surgery, 30(1), 161-168. https://doi.org/10.1007/s11695-019-04164-0

Downloads

Published

2022-01-26

How to Cite

1.
Lavryk AS, Kucheruk VV, Dmytrenko OP, Tereshkevych IS, Lytvynchuk HM, Razdobudko YM. Gastroesophageal reflux disease in patients with morbid obesity. Zaporozhye Medical Journal [Internet]. 2022Jan.26 [cited 2024Nov.24];24(1):23-9. Available from: http://zmj.zsmu.edu.ua/article/view/219086

Issue

Vol. 24 No. 1 (2022)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)