Department of Surgery, Upper GI Research and Service, Comprehensive Cancer Center, Gastroesophageal Tumor Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Surgery, Metabolic & Bariatric Surgery, Medical University of Vienna, Vienna, Austria.
Obes Surg. 2019 Nov;29(11):3536-3541. doi: 10.1007/s11695-019-04020-1.
The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population.
Consecutive morbidly obese (BMI ≥ 35 kg/m) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively.
Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively.
The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.
高分辨率测压（HRM）和里昂共识的实施有助于评估病态肥胖患者的胃食管反流病和动力障碍。因此，我们旨在研究该人群中（临界）胃食管反流病和食管动力障碍的患病率和表型。
连续选择病态肥胖（BMI≥35kg/m²）患者在我们的三级学术中心接受 HRM、24 小时 pH 阻抗监测、内窥镜检查和临床检查。前瞻性收集数据。
在 448 名符合条件的个体中，有 147 名患者（女性=75，51%）符合条件，中位年龄为 41.6（33.4；52.3）岁，BMI 为 44（40.9；49.4）kg/m²。芝加哥分类显示 50 名患者（34%）存在动力障碍，主要为流出道梗阻（18.4%，n=27）和一种新的疾病（7.5%，n=11），命名为痉挛性食管（JE）。根据里昂共识，52 名患者（35.4%）有真正的 GERD 证据，而另外 60 名患者（40.8%）有 GERD 边缘证据。超敏性食管见于 6.8%（n=10）。GERD 症状的敏感性和特异性分别为 53.8%和 68.4%。
目前的评估金标准显示，病态肥胖人群中食管动力障碍和（临界）GERD 的患病率很高。需要进一步的纵向数据来描绘肥胖中新型动力障碍（如 JE）的自然病程，并确定肥胖症患者接受减肥手术后不良结局的危险因素。
