Gastroesophageal reflux in the massively obese

Symptom review, barium swallow, endoscopy and esophageal manometry were performed on 55 massively obese patients, greater than twice ideal weight. Symptoms of reflux and/or heartburn were present in 40 patients (72.7%). Symptoms were present in 81.5% of the 27 patients aged greater than or equal to 35 yr and 64.3% of the 28 patients less than 35 yr (p less than 0.01). Upper GI series showed hiatal hernia in 16 and spontaneous reflux in 9 patients (7 with hiatal hernias). Endoscopy revealed hiatal hernia and/or esophagitis in 17 patients. Mean lower esophageal sphincter (LES) pressure was 15.2 +/- 7.3 mmHg, with 47.3% of patients having subnormal pressure (less than 15). Patients greater than or equal to 35 yr had reduced LES pressure 11.9 +/- 6.4 mmHg, whereas patients less than 35 yr had LES pressure 18.6 +/- 6.7 (p less than 0.001). Of patients greater than or equal to 35 yr, 70.4% had subnormal LES pressure compared to 25.0% less than 35 yr. Incidence of reduced LES pressure increased as the graded severity of esophageal symptoms increased. Patients greater than or equal to 35 yr had significantly lower LES pressure and higher incidence of reflux symptoms than those younger. For comparison, asymptomatic control groups greater than or equal to and less than 35 yr showed no difference in LES pressure.