ESOPHAGEAL FUNCTIONAL DISORDERS IN THE PRE-OPERATORY EVALUATION OF BARIATRIC SURGERY

Area of Science:

• Gastroenterology
• Bariatric Surgery
• Esophageal Physiology

Background:

• Obesity is a significant risk factor for esophageal dysfunction, including GERD and motor abnormalities.
• Pre-operative evaluation for bariatric surgery in Type III obesity patients includes EGD, EMN, and PHM.

Purpose of the Study:

• To describe EGD, EMN, and PHM findings in Type III obesity patients undergoing bariatric surgery evaluation.
• To correlate these findings with typical GERD symptoms.

Main Methods:

• Retrospective study of 114 Type III obesity patients.
• Assessment of GERD symptoms (heartburn, regurgitation).
• Performance of esophageal manometry (EMN), prolonged pHmetry (PHM), and esophagogastroduodenoscopy (EGD).

Main Results:

• 43% of patients reported GERD symptoms; 62% were asymptomatic.
• Esophageal abnormalities (hiatal hernia, erosive esophagitis) found in 42% of EGDs.
• Abnormal manometry (hypotensive LES, ineffective esophageal motility) in 45% of patients.
• Abnormal reflux detected by pHmetry in 53% of patients.
• No significant correlation found between symptoms and manometry or pHmetry findings.

Conclusions:

• Motor abnormalities are prevalent in Type III obesity patients, with hypotensive LES and ineffective esophageal motility being most common.
• A significant proportion of patients, symptomatic or asymptomatic, exhibit abnormal esophageal motility and/or reflux.
• Pre-operative esophageal testing is valuable for identifying subclinical abnormalities in this population.