Dysfunction of the lower esophageal sphincter and dysmotility of the tubular esophagus in morbidly obese patients

Abstract

Patients with morbid obesity (=BMI>40 kg/m2) have a dysfunction of the LES and an altered esophageal motility, even when they are asymptomatic for GERD symptoms.

Obese Patients Have Stronger Peristalsis and Increased Acid Exposure in the Esophagus

“…However, recent studies on the relation between obesity and esophageal motility provide conflicting findings. Kuper et al [27] described lower values of LES pressure and esophageal body contraction amplitude in morbidly obese patients compared to non-obese individuals, whereas Schneider and colleagues found higher contraction amplitude in esophageal body of patients with the highest BMI compared to patients with lower BMI [28]. Further studies are needed to clarify this issue.…”

Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery

“…However, typical upper gastrointestinal symptoms of GERD, such as heartburn and chest pain, often are absent in these patients. Manometry and pH-metry studies have shown that both symptomatic and asymptomatic morbidly obese individuals have a reduced resting pressure in the lower esophageal sphincter, as well as disturbed esophageal motility, which can lead to an increased incidence of GERD in these patients [25][26][27][28][29]. However, data for macroscopic findings in the upper gastrointestinal tract in morbidly obese patients are still scarce and contradictory regarding both peri-procedure morbidity and rates of pathological findings [16][17][18][19].…”

Gastroesophageal Reflux Disease and Sleeve Gastrectomy

“…Obesity is a known risk factor for GERD and/or hiatus hernia (HH) as well as for erosive esophagitis and esophageal adenocarcinoma [2,3]. Approximately 50-70 % of patients undergoing bariatric surgery for morbid obesity have symptomatic reflux, while a concomitant HH is present in 15 % of patients with BMI >35 kg/m 2 [1].…”

“…This makes the diagnosis and assessment of GERD difficult, particularly when manometry and/or pH metry is not performed as routine [2].…”