William A Nehmeh1,2, Clement Baratte1,2,3, Claire Rives-Lange1,4, Chloe Martineau1,5, Hortense Boullenois1,2, Sylvia Krivan6, Vincent Guillet1,2, Maude Le Gall1,3, Christophe Cellier1,5, Claire Carette1,3, Sebastien Czernichow1,4,7, Jean-Marc Chevallier1,2, Tigran Poghosyan8,9,10. 1. Université de Paris, Paris, France. 2. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, Oncologique et Bariatrique, Hôpital Européen Georges Pompidou, Paris, France. 3. Inserm UMRS 1149, Paris, France. 4. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France. 5. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Gastro-Entero-Hépatologie, Hôpital Européen Georges Pompidou, Paris, France. 6. Department of Digestive Surgery, Royal Derby Hospital, Derby, UK. 7. Information sciences to support personalized medicine, INSERM, Cordeliers Research Center, Paris, France. 8. Université de Paris, Paris, France. tigran.poghosyan@aphp.fr. 9. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, Oncologique et Bariatrique, Hôpital Européen Georges Pompidou, Paris, France. tigran.poghosyan@aphp.fr. 10. Inserm UMRS 1149, Paris, France. tigran.poghosyan@aphp.fr.
Abstract
INTRODUCTION: Patients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear. OBJECTIVE: To assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB. METHODS: Retrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019. RESULTS: Mean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux. CONCLUSION: Acid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.
INTRODUCTION:Patients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear. OBJECTIVE: To assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB. METHODS: Retrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019. RESULTS: Mean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux. CONCLUSION: Acid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.