Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass
| Autor: | Philipp C. Nett, Dino Kröll, Johannes Lenglinger, Yves Michael Borbély, Radu Tutuian, Peter Moreno |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Gastric Bypass 030209 endocrinology & metabolism 610 Medicine & health Multimodal Imaging Hiatal hernia 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Esophageal Motility Disorders Intraoperative Complications Aged Retrospective Studies medicine.diagnostic_test business.industry Reflux Middle Aged medicine.disease Roux-en-Y anastomosis Magnetic Resonance Imaging digestive system diseases Surgery Endoscopy Obesity Morbid Cross-Sectional Studies Hernia Hiatal Esophageal motility disorder Chronic Disease GERD Gastroesophageal Reflux 030211 gastroenterology & hepatology Median body Female business Tomography X-Ray Computed Esophagitis |
| Zdroj: | Borbély, Yves Michael; Nett, Philipp C.; Kröll, Dino; Moreno, Peter; Tutuian, Radu; Lenglinger, Johannes (2017). Radiologic, Endoscopic and Functional Patterns in Patients with Symptomatic Gastroesophageal Reflux Disease after Roux-en-Y Gastric Bypass (Unpublished). In: Schweizerische Gesellschaft für Chirurgie Kongress 2017. Bern. 31.5.-2.6.2017. Borbély, Yves Michael; Nett, Philipp C.; Kröll, Dino; Moreno, Peter; Tutuian, Radu; Lenglinger, Johannes (2017). Radiologic, Endoscopic and Functional Patterns in Patients with Symptomatic Gastroesophageal Reflux Disease after Roux-en-Y Gastric Bypass (Unpublished). In: Digestive Disease Week 2017. |
| DOI: | 10.7892/boris.125792 |
| Popis: | BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%. OBJECTIVE To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors. SETTING University hospital, cross-sectional study. METHODS Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow. RESULTS Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8-12.6); median patient age was 36.5 years (19.1-67.2). Median body mass index was 30.3 kg/m (20.3-47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off-proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%). CONCLUSION The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment. |
| Databáze: | OpenAIRE |
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