BACKGROUND: Morbid obesity is associated with gastroesophageal reflux disease (GERD), and both have an independent association with motility disorders. Impaired esophageal function is thought to play a role in the development of dysphagia after fundoplication and bariatric procedures (especially restrictive procedures). The authors aimed to define both the physiology and the underlying pathophysiology of swallowing using a novel technique, multichannel intraluminal impedance (MII), which can accurately determine the clearance of a swallowed bolus through the esophagus, in combination with traditional manometry, which can measure peristalsis. METHODS: Simultaneous MII, manometry, and pH monitoring were performed for 10 asymptomatic subjects, 22 consecutive nonobese patients with GERD (GERD), and 22 consecutive morbidly obese patients with GERD (MO-GERD) who were under evaluation for antireflux and bariatric surgery at the University of Washington. In this study, MII was defined as abnormal if less than 80% of swallowed liquid boluses cleared the esophagus completely. RESULTS: All GERD and MO-GERD patients had abnormal pH monitoring. The manometric findings were similar for the GERD and MO-GERD patients. All the asymptomatic subjects had normal manometry and impedance test results. Abnormal manometry would have predicted that approximately 23% of GERD and MO-GERD patients had defective emptying. However, when measured with impedance, esophageal clearance was found to be defective in two times as many GERD and nearly three times as many MO-GERD patients. CONCLUSIONS: In patients with GERD, impedance often detects impairments in esophageal motility not identified by manometry. Morbidly obese patients with GERD have a higher incidence of impaired esophageal motility than nonobese patients with GERD. This may have implications for bariatric procedures, especially those that are restrictive.
BACKGROUND: Morbid obesity is associated with gastroesophageal reflux disease (GERD), and both have an independent association with motility disorders. Impaired esophageal function is thought to play a role in the development of dysphagia after fundoplication and bariatric procedures (especially restrictive procedures). The authors aimed to define both the physiology and the underlying pathophysiology of swallowing using a novel technique, multichannel intraluminal impedance (MII), which can accurately determine the clearance of a swallowed bolus through the esophagus, in combination with traditional manometry, which can measure peristalsis. METHODS: Simultaneous MII, manometry, and pH monitoring were performed for 10 asymptomatic subjects, 22 consecutive nonobese patients with GERD (GERD), and 22 consecutive morbidly obesepatients with GERD (MO-GERD) who were under evaluation for antireflux and bariatric surgery at the University of Washington. In this study, MII was defined as abnormal if less than 80% of swallowed liquid boluses cleared the esophagus completely. RESULTS: All GERD and MO-GERDpatients had abnormal pH monitoring. The manometric findings were similar for the GERD and MO-GERDpatients. All the asymptomatic subjects had normal manometry and impedance test results. Abnormal manometry would have predicted that approximately 23% of GERD and MO-GERDpatients had defective emptying. However, when measured with impedance, esophageal clearance was found to be defective in two times as many GERD and nearly three times as many MO-GERDpatients. CONCLUSIONS: In patients with GERD, impedance often detects impairments in esophageal motility not identified by manometry. Morbidly obesepatients with GERD have a higher incidence of impaired esophageal motility than nonobese patients with GERD. This may have implications for bariatric procedures, especially those that are restrictive.
Authors: Ramesh Srinivasan; Radu Tutuian; Philip Schoenfeld; Marcelo F Vela; June A Castell; Thomas Isaac; Irfan Galaria; Philip O Katz; Donald O Castell Journal: J Clin Gastroenterol Date: 2004-09 Impact factor: 3.062
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Authors: Radu Tutuian; Marcelo F Vela; Nagammapudur S Balaji; James L Wise; Joseph A Murray; Jeffrey H Peters; Steven S Shay; Donald O Castell Journal: Clin Gastroenterol Hepatol Date: 2003-05 Impact factor: 11.382
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Authors: M A Küper; K M Kramer; A Kirschniak; A Kischniak; M Zdichavsky; J H Schneider; D Stüker; T Kratt; A Königsrainer; F A Granderath Journal: Obes Surg Date: 2009-06-10 Impact factor: 4.129