Georgia Doulami1, Stamatina Triantafyllou2, Maria Natoudi3, Konstantinos Albanopoulos3, Evangelos Menenakos3, Konstantinos Filis4, Georgios Zografos4, Dimitrios Theodorou2. 1. Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, "Hippokration" General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527, Athens, Greece. tzinagb@yahoo.gr. 2. Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, "Hippokration" General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527, Athens, Greece. 3. Department of Bariatric Surgery, 1st Propaedeutic Surgical Clinic, "Hippokration" General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece. 4. 1st Propaedeutic Surgical Clinic, "Hippokration" General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
BACKGROUND: Although several studies reporting normal values of 24h multichannel intraluminal impedance pH (MIIpH) have been published, none of them has ever studied obese individuals. The purpose of this study is to determine overall frequency and duration of reflux episodes (acid and non-acid, supine-upright, post and preprandial) in obese asymptomatic volunteers. METHODS: Obese volunteers were enlisted during their preoperative evaluation for bariatric surgery. Volunteers had no gastroesophageal reflux disease (GERD) symptoms and no evidence of esophageal mucosal injury on endoscopy. Participants underwent a 24h MIIpH. RESULTS: In this prospective observational study, data of 22 obese individuals were analyzed. Mean age was 41.9 years and mean BMI was 47.1 kg/m(2). Mean total reflux episodes was 55.6 and 95th percentile was 99.7. Mean percentage of total time with pH <4 was 2.59 % and 95th percentile was 8.57 %. Mean percentage of bolus exposure was 1.84 % with 95th percentile being 4.47 %. Postprandial acid reflux episodes were statistical significant more frequent in comparison to preprandial acid reflux episodes (19.41 vs. 15, p = 0.008). Mean acid clearance duration was 3.6 times higher than median bolus clearance duration (56.05 and 15.55 s, respectively, p = 0.868). CONCLUSION: Our study is the first to provide normal values of 24h MIIpH of asymptomatic obese. Normal values of 24h MIIpH of obese asymptomatic individuals differ from the reported normal values of non-obese healthy individuals; having more reflux episodes and equal or slightly higher median bolus exposure and acid clearance. Our results imply that new cut-off values should be employed in order to define GERD in obese individuals.
BACKGROUND: Although several studies reporting normal values of 24h multichannel intraluminal impedance pH (MIIpH) have been published, none of them has ever studied obese individuals. The purpose of this study is to determine overall frequency and duration of reflux episodes (acid and non-acid, supine-upright, post and preprandial) in obese asymptomatic volunteers. METHODS:Obese volunteers were enlisted during their preoperative evaluation for bariatric surgery. Volunteers had no gastroesophageal reflux disease (GERD) symptoms and no evidence of esophageal mucosal injury on endoscopy. Participants underwent a 24h MIIpH. RESULTS: In this prospective observational study, data of 22 obese individuals were analyzed. Mean age was 41.9 years and mean BMI was 47.1 kg/m(2). Mean total reflux episodes was 55.6 and 95th percentile was 99.7. Mean percentage of total time with pH <4 was 2.59 % and 95th percentile was 8.57 %. Mean percentage of bolus exposure was 1.84 % with 95th percentile being 4.47 %. Postprandial acid reflux episodes were statistical significant more frequent in comparison to preprandial acid reflux episodes (19.41 vs. 15, p = 0.008). Mean acid clearance duration was 3.6 times higher than median bolus clearance duration (56.05 and 15.55 s, respectively, p = 0.868). CONCLUSION: Our study is the first to provide normal values of 24h MIIpH of asymptomatic obese. Normal values of 24h MIIpH of obese asymptomatic individuals differ from the reported normal values of non-obese healthy individuals; having more reflux episodes and equal or slightly higher median bolus exposure and acid clearance. Our results imply that new cut-off values should be employed in order to define GERD in obese individuals.
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