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Erschienen in: Surgical Endoscopy 5/2007

01.05.2007

Esophageal motility disorders in the morbidly obese population

verfasst von: J. S. Koppman, L. Poggi, S. Szomstein, A. Ukleja, A. Botoman, R. Rosenthal

Erschienen in: Surgical Endoscopy | Ausgabe 5/2007

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Abstract

Background

Most studies investigating esophageal motility among the morbidly obese have focused on the relationship between lower esophageal sphincter (LES) pressure and gastroesophageal reflux disease (GERD). Very few studies in the literature have examined motility disorders among the morbidly obese population in general outside the context of GERD. This study aimed to determine the prevalence of esophageal motility disorders in obese patients selected for bariatric surgery.

Methods

A total of 116 obese patients (81 women and 35 men) selected for laparoscopic gastric banding underwent manometric evaluation of their esophagus from January to March 2003. Tracings were retrospectively reviewed for the end points of LES resting pressure, LES relaxation, and esophageal peristalsis.

Results

The study patients had a body mass index (BMI) of 42.9 kg/m2, and a mean age of 48.6 years. The following abnormal manometric findings were demonstrated in 41% of the patients: nonspecific esophageal motility disorders (23%), nutcracker esophagus (peristaltic amplitude >180 mmHg) (11%), isolated hypertensive LES pressure (>35 mmHg) (3%), isolated hypotensive LES pressure (<12 mmHg) (3%), diffuse esophageal spasm (1%), and achalasia (1%). Only one patient with abnormal esophageal motility reported noncardiac chest pain.

Conclusions

Despite a high prevalence of esophageal dysmotility in our morbidly obese study population, there was a conspicuous absence of symptoms. Although the patients in this study were not directly questioned with regard to esophageal symptoms, several studies in the literature support our conclusion.
Literatur
1.
Zurück zum Zitat Backman L, Granstrom L, Lindahl J, Melcher A (1983) Manometric studies of lower esophageal sphincter in extreme obesity. Acta Chir Scand 149: 193–197PubMed Backman L, Granstrom L, Lindahl J, Melcher A (1983) Manometric studies of lower esophageal sphincter in extreme obesity. Acta Chir Scand 149: 193–197PubMed
2.
Zurück zum Zitat Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD (2002) Gastroesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev 3: 9–15PubMedCrossRef Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD (2002) Gastroesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev 3: 9–15PubMedCrossRef
3.
Zurück zum Zitat Buchwald H (2005) Consensus Conference Statement: bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 200: 593–604PubMedCrossRef Buchwald H (2005) Consensus Conference Statement: bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 200: 593–604PubMedCrossRef
4.
Zurück zum Zitat Clouse R, Staiano A (1983) Contraction abnormalities of the esophageal body in patients referred for manometry: a new approach to manometric classification. Dig Dis Sci 28: 784–791PubMedCrossRef Clouse R, Staiano A (1983) Contraction abnormalities of the esophageal body in patients referred for manometry: a new approach to manometric classification. Dig Dis Sci 28: 784–791PubMedCrossRef
5.
Zurück zum Zitat Fisher B, Pennathur A, Mutnick J, Little A (1999) Obesity correlates with gastroesophageal reflux. Dig Dis Sci 44: 2290–2294PubMedCrossRef Fisher B, Pennathur A, Mutnick J, Little A (1999) Obesity correlates with gastroesophageal reflux. Dig Dis Sci 44: 2290–2294PubMedCrossRef
6.
Zurück zum Zitat Frezza E, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roun-en-Y gastric bypass. Surg Endosc 16: 1027–1031PubMedCrossRef Frezza E, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roun-en-Y gastric bypass. Surg Endosc 16: 1027–1031PubMedCrossRef
7.
Zurück zum Zitat Grande L, Lacima G, Ros E, Pera M, Ascaso C, Visa J, Pera C. (1999) Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects. Am J Gastroenterol 94: 1795–1801PubMedCrossRef Grande L, Lacima G, Ros E, Pera M, Ascaso C, Visa J, Pera C. (1999) Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects. Am J Gastroenterol 94: 1795–1801PubMedCrossRef
8.
Zurück zum Zitat Greenstein RJ, Nissan A, Jaffin B (1998) Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg 8: 199–206PubMedCrossRef Greenstein RJ, Nissan A, Jaffin B (1998) Esophageal anatomy and function in laparoscopic gastric restrictive bariatric surgery: implications for patient selection. Obes Surg 8: 199–206PubMedCrossRef
9.
Zurück zum Zitat Hampel H, Abraham N, El-Serag H (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Int Med 143: 199–211PubMed Hampel H, Abraham N, El-Serag H (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Int Med 143: 199–211PubMed
10.
Zurück zum Zitat Hong D, Kamath M, Wang S, Tabet J, Tougas G, Anvari M (2002). Assessment of the afferent vagal nerve in patients with gastroesophageal reflux. Surg Endosc 16: 1042–1045PubMedCrossRef Hong D, Kamath M, Wang S, Tabet J, Tougas G, Anvari M (2002). Assessment of the afferent vagal nerve in patients with gastroesophageal reflux. Surg Endosc 16: 1042–1045PubMedCrossRef
11.
Zurück zum Zitat Hong D, Khajanchee Y, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL. (2004) Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg 14: 744–749PubMedCrossRef Hong D, Khajanchee Y, Pereira N, Lockhart B, Patterson EJ, Swanstrom LL. (2004) Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg 14: 744–749PubMedCrossRef
12.
Zurück zum Zitat Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, Sabbatini F, Mazzacca G, Ciacci C. (2002) Abnormal esophageal acid exposure is common in morbidly obese patients and improves after successful Lap-Band system implantation. Surg Endosc 16: 1631–1635PubMedCrossRef Iovino P, Angrisani L, Tremolaterra F, Nirchio E, Ciannella M, Borrelli V, Sabbatini F, Mazzacca G, Ciacci C. (2002) Abnormal esophageal acid exposure is common in morbidly obese patients and improves after successful Lap-Band system implantation. Surg Endosc 16: 1631–1635PubMedCrossRef
13.
Zurück zum Zitat Jaffin B, Knoeplmacher P, Greenstein R (1999) High prevalence of asymptomatic esophageal motility disorders among morbidly obese patient. Obes Surg 9: 390–395PubMedCrossRef Jaffin B, Knoeplmacher P, Greenstein R (1999) High prevalence of asymptomatic esophageal motility disorders among morbidly obese patient. Obes Surg 9: 390–395PubMedCrossRef
14.
Zurück zum Zitat Kjellin A, Ramel S, Rossner S, Thor K (1996) Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 1: 1047–1051 Kjellin A, Ramel S, Rossner S, Thor K (1996) Gastroesophageal reflux in obese patients is not reduced by weight reduction. Scand J Gastroenterol 1: 1047–1051
15.
Zurück zum Zitat Lagergren J, Bergstrom R, Nyren O (2001) No relation between body mass and gastroesophageal reflux symptoms in a Swedish population–based study. Gut 48: 578–579CrossRef Lagergren J, Bergstrom R, Nyren O (2001) No relation between body mass and gastroesophageal reflux symptoms in a Swedish population–based study. Gut 48: 578–579CrossRef
16.
Zurück zum Zitat Lundell L, Ruth M, Sandberg N, Bove-Nielsen M (1995) Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 40: 1632–1635PubMedCrossRef Lundell L, Ruth M, Sandberg N, Bove-Nielsen M (1995) Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 40: 1632–1635PubMedCrossRef
17.
Zurück zum Zitat Mercer C, Rue C, Hanelin L, Hill LD (1985) Effect of obesity on esophageal transit. Am J Surg 149: 177–181PubMedCrossRef Mercer C, Rue C, Hanelin L, Hill LD (1985) Effect of obesity on esophageal transit. Am J Surg 149: 177–181PubMedCrossRef
18.
Zurück zum Zitat O’brien TF Jr (1980) Lower esophageal sphincter pressure (LESP) and esophageal function in obese humans. J Clin Gastroenterol 2: 145–148PubMedCrossRef O’brien TF Jr (1980) Lower esophageal sphincter pressure (LESP) and esophageal function in obese humans. J Clin Gastroenterol 2: 145–148PubMedCrossRef
19.
Zurück zum Zitat Peterson H, Rothschild M, Weinberg C, Fell RD, McLeish KR, Pfeifer MA. (1988) Body fat and the activity of the autonomic nervous system. N Engl J Med 318: 1077–1083PubMedCrossRef Peterson H, Rothschild M, Weinberg C, Fell RD, McLeish KR, Pfeifer MA. (1988) Body fat and the activity of the autonomic nervous system. N Engl J Med 318: 1077–1083PubMedCrossRef
20.
Zurück zum Zitat Richter J, Wu W, Johns D, Blackwell JN, Nelson JL 3rd, Castell JA, Castell DO. (1987) Esophageal manometry in 95 healthy adult volunteers: variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32: 583–592PubMedCrossRef Richter J, Wu W, Johns D, Blackwell JN, Nelson JL 3rd, Castell JA, Castell DO. (1987) Esophageal manometry in 95 healthy adult volunteers: variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32: 583–592PubMedCrossRef
21.
Zurück zum Zitat Sugarbaker D, Kearney D, Richards W (1993) Esophageal physiology and pathophysiology. Surg Clin North Am 73: 1101–1116PubMed Sugarbaker D, Kearney D, Richards W (1993) Esophageal physiology and pathophysiology. Surg Clin North Am 73: 1101–1116PubMed
22.
Zurück zum Zitat Suter M, Dorta G, Giusti V, Calmes JM (2004) Gatroesophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14: 959–966PubMedCrossRef Suter M, Dorta G, Giusti V, Calmes JM (2004) Gatroesophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14: 959–966PubMedCrossRef
23.
Zurück zum Zitat Suter M, Dorta G, Giusti V, Calmes JM (2005) Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 140: 639–643PubMedCrossRef Suter M, Dorta G, Giusti V, Calmes JM (2005) Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg 140: 639–643PubMedCrossRef
24.
Zurück zum Zitat Verset D, Houben JJ, Gay F, Elcheroth J, Bourgeois V, Van Gossum A. (1997) The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci 42: 2333–2337PubMedCrossRef Verset D, Houben JJ, Gay F, Elcheroth J, Bourgeois V, Van Gossum A. (1997) The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. Dig Dis Sci 42: 2333–2337PubMedCrossRef
25.
Zurück zum Zitat Weihrauch TR, Vallerius P, Alpers H, Ewe K (1980) Assessment of various factors influencing esophageal pressure measurement: II. Significance of physiological factors in intraluminal manometry. Klinische Wochenschrift 58: 287–292PubMedCrossRef Weihrauch TR, Vallerius P, Alpers H, Ewe K (1980) Assessment of various factors influencing esophageal pressure measurement: II. Significance of physiological factors in intraluminal manometry. Klinische Wochenschrift 58: 287–292PubMedCrossRef
26.
Zurück zum Zitat Weiss H, Nehoda H, Labeck B, Peer-Kuhberger MD, Klingler P, Gadenstatter M, Aigner F, Westscher GJ. (2000) Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 180: 479–482PubMedCrossRef Weiss H, Nehoda H, Labeck B, Peer-Kuhberger MD, Klingler P, Gadenstatter M, Aigner F, Westscher GJ. (2000) Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 180: 479–482PubMedCrossRef
27.
Zurück zum Zitat Wilson L, Wenzhou M, Hirschowitz B (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94: 2840–2844PubMedCrossRef Wilson L, Wenzhou M, Hirschowitz B (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94: 2840–2844PubMedCrossRef
28.
Zurück zum Zitat Xing J, Chen J (2004) Alterations of gastrointestinal motility in obesity. Obes Res 12: 1723–1732PubMedCrossRef Xing J, Chen J (2004) Alterations of gastrointestinal motility in obesity. Obes Res 12: 1723–1732PubMedCrossRef
29.
Zurück zum Zitat Zacchi P, Mearin F, Humbert P, Formiguera X, Malagelada JR (1991) Effect of obesity on gastroesophageal resistance to flow in man. Dig Dis Sci 36: 1473–1480PubMedCrossRef Zacchi P, Mearin F, Humbert P, Formiguera X, Malagelada JR (1991) Effect of obesity on gastroesophageal resistance to flow in man. Dig Dis Sci 36: 1473–1480PubMedCrossRef
Metadaten
Titel
Esophageal motility disorders in the morbidly obese population
verfasst von
J. S. Koppman
L. Poggi
S. Szomstein
A. Ukleja
A. Botoman
R. Rosenthal
Publikationsdatum
01.05.2007
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 5/2007
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9102-y

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