Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) in morbidly obese patients. Background: Symptomatic GERD is considered by many a contraindication to LSG. However, studies evaluating the relationship between LSG and GERD by 24-hour pH monitoring are lacking. Methods: Consecutive morbidly obese patients selected for LSG were included in a prospective clinical study. Gastroesophageal function was evaluated using a clinical validated questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring before and 24 months after LSG. This trial is registered with ClinicalTrials.gov (no. NCT02012894). Results: From June 2009 to September 2011, a total of 71 patients were enrolled into the study; 65 (91.5%) completed the 2-year protocol. On the basis of preoperative 24-hour pH monitoring, patients were divided into group A (pathologic, n = 28) and group B (normal, n = 37). Symptoms improved in group A, with the Gastroesophageal Reflux Disease Symptom Assessment Scale score decreasing from 53.1 +/- 10.5 to 13.1 +/- 3.5 (P < 0.001). The DeMeester score and total acid exposure (% pH < 4) decreased in group A patients (DeMeester score from 39.5 +/- 16.5 to 10.6 +/- 5.8, P < 0.001; % pH < 4 from 10.2 +/- 3.7 to 4.2 +/- 2.6, P < 0.001). Real "de novo" GERD occurred in 5.4% group B patients. No significant changes in lower esophageal sphincter pressure and esophageal peristalsis amplitude were found in both groups. Conclusions: LSG improves symptoms and controls reflux in most morbidly obese patients with preoperative GERD. In obese patients without preoperative evidence of GERD, the occurrence of "de novo" reflux is uncommon. Therefore, LSG should be considered an effective option for the surgical treatment of obese patients with GERD.

Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation.

REBECCHI, Fabrizio;ALLAIX, Marco Ettore;GIACCONE, Claudio;UGLIONO, ELETTRA;SCOZZARI, Gitana;MORINO, Mario
2014-01-01

Abstract

Objective: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) in morbidly obese patients. Background: Symptomatic GERD is considered by many a contraindication to LSG. However, studies evaluating the relationship between LSG and GERD by 24-hour pH monitoring are lacking. Methods: Consecutive morbidly obese patients selected for LSG were included in a prospective clinical study. Gastroesophageal function was evaluated using a clinical validated questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring before and 24 months after LSG. This trial is registered with ClinicalTrials.gov (no. NCT02012894). Results: From June 2009 to September 2011, a total of 71 patients were enrolled into the study; 65 (91.5%) completed the 2-year protocol. On the basis of preoperative 24-hour pH monitoring, patients were divided into group A (pathologic, n = 28) and group B (normal, n = 37). Symptoms improved in group A, with the Gastroesophageal Reflux Disease Symptom Assessment Scale score decreasing from 53.1 +/- 10.5 to 13.1 +/- 3.5 (P < 0.001). The DeMeester score and total acid exposure (% pH < 4) decreased in group A patients (DeMeester score from 39.5 +/- 16.5 to 10.6 +/- 5.8, P < 0.001; % pH < 4 from 10.2 +/- 3.7 to 4.2 +/- 2.6, P < 0.001). Real "de novo" GERD occurred in 5.4% group B patients. No significant changes in lower esophageal sphincter pressure and esophageal peristalsis amplitude were found in both groups. Conclusions: LSG improves symptoms and controls reflux in most morbidly obese patients with preoperative GERD. In obese patients without preoperative evidence of GERD, the occurrence of "de novo" reflux is uncommon. Therefore, LSG should be considered an effective option for the surgical treatment of obese patients with GERD.
260
5
909
915
http://www.ncbi.nlm.nih.gov/pubmed/?term=10.1097%2FSLA.0000000000000967
Rebecchi F; Allaix ME; Giaccone C; Ugliono E; Scozzari G; Morino M.
File in questo prodotto:
File Dimensione Formato  
gastroesophageal reflux.pdf

Open Access dal 31/01/2016

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 604.86 kB
Formato Adobe PDF
604.86 kB Adobe PDF Visualizza/Apri
00000658-201411000-00026.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 157.03 kB
Formato Adobe PDF
157.03 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/152885
Citazioni
  • ???jsp.display-item.citation.pmc??? 19
  • Scopus 116
  • ???jsp.display-item.citation.isi??? 115
social impact