Tolone Salvatore, Savarino Edoardo Vincenzo, De Bortoli Nicola, Lucido Francesco Saverio, Gambardella Claudio, Brusciano Luigi, Parisi Simona, Del Genio Gianmattia, Ruggiero Roberto, Docimo Ludovico
General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy.
Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Updates Surg. 2025 Mar 13. doi: 10.1007/s13304-025-02167-4.
Obesity is linked to increased risk of gastroesophageal reflux disease (GERD) and esophageal motility disorders, both of which may impact outcomes in metabolic and bariatric surgery (MBS). GERD pathophysiology in obesity includes elevated intraabdominal pressure and altered esophagogastric junction (EGJ) function. High resolution manometry (HRM) and 24-h esophageal pH-impedance (MII-pH) monitoring are vital in evaluating GERD, yet normative values specific to populations with obesity are limited, risking misdiagnosis if lean data are used. This study establishes normative HRM and MII-pH values in asymptomatic individuals with obesity, compared to normal-weight controls, to guide accurate diagnosis and treatment. A retrospective analysis was conducted on asymptomatic patients with obesity (BMI ≥ 30) and normal-weight controls (BMI 20-25) who underwent HRM and MII-pH prior to MBS between 2015 and 2024. Exclusion criteria included GERD symptoms, esophagitis, and prior gastrointestinal surgery. Key HRM parameters (LES pressure, EGJ morphology) and MII-pH metrics (acid exposure time, reflux episodes) were recorded and analyzed. Of the 96 patients with obesity and 25 normal-weight participants, significant differences in HRM and MII-pH results were observed. Individuals with obesity showed increased intra-gastric pressure, gastroesophageal pressure gradient, and higher acid exposure time. While LES pressure and EGJ morphology were similar to controls, participants with obesity exhibited distinct reflux patterns, especially postprandial, suggesting obesity-specific physiological changes. This study establishes normative HRM and MII-pH values for asymptomatic individuals with obesity, highlighting critical differences from normal-weight controls. Obesity-specific diagnostic criteria are essential for accurate GERD diagnosis, particularly for MBS candidates, to improve management and predict potential postoperative complications.
肥胖与胃食管反流病（GERD）和食管动力障碍的风险增加有关，这两者都可能影响代谢和减重手术（MBS）的结果。肥胖人群中GERD的病理生理学包括腹内压升高和食管胃交界（EGJ）功能改变。高分辨率测压法（HRM）和24小时食管pH阻抗（MII-pH）监测对于评估GERD至关重要，但肥胖人群的正常参考值有限，如果使用瘦体重人群的数据则有误诊风险。本研究确定了肥胖无症状个体与正常体重对照组相比的HRM和MII-pH正常参考值，以指导准确的诊断和治疗。对2015年至2024年间在接受MBS之前接受HRM和MII-pH检查的肥胖无症状患者（BMI≥30）和正常体重对照组（BMI 20-25）进行了回顾性分析。排除标准包括GERD症状、食管炎和既往胃肠道手术史。记录并分析了关键的HRM参数（LES压力、EGJ形态）和MII-pH指标（酸暴露时间、反流发作次数）。在96例肥胖患者和25例正常体重参与者中，观察到HRM和MII-pH结果存在显著差异。肥胖个体表现出胃内压升高、胃食管压力梯度增加和酸暴露时间延长。虽然LES压力和EGJ形态与对照组相似，但肥胖参与者表现出独特的反流模式，尤其是餐后反流模式，提示存在肥胖特异性的生理变化。本研究确定了肥胖无症状个体的HRM和MII-pH正常参考值，突出了与正常体重对照组的关键差异。肥胖特异性诊断标准对于准确诊断GERD至关重要，特别是对于MBS候选者，以改善管理并预测潜在的术后并发症。
