Radiologic, Endoscopic and Functional Patterns in Patients with Symptomatic Gastroesophageal Reflux Disease after Roux-en-Y Gastric Bypass

Borbély, Yves Michael; Nett, Philipp C.; Kröll, Dino; Moreno, Peter; Tutuian, Radu; Lenglinger, Johannes (2017). Radiologic, Endoscopic and Functional Patterns in Patients with Symptomatic Gastroesophageal Reflux Disease after Roux-en-Y Gastric Bypass (Unpublished). In: Digestive Disease Week 2017.

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Introduction: Roux-en-Y gastric Bypass (RYGB) is considered as gold standard in treatment of morbid obesity and Gastroesophageal Reflux Disease (GERD). Resolution of GERD-Symptoms is reported to be around 85-90%. So far, data on evaluation for persistent GERD after RYGB is scarce. Methods: Data of patients evaluated for persistent GERD with a history of RYGB between 01/12 and 12/15 were reviewed. GERD was assessed with questionnaires, endoscopy, 24h-pH-impendance-manometry and barium swallow. Results: Of 39 patients, 34(87.2%) presented with typical GERD, 16(41%) with obstructive, 7(17.9%) with pulmonary symptoms and 15(38.5%) with pain. All patients were on at least daily PPI. The interval between RYGB and evaluation was a median 3.9 years (min 0.8 – max 12.6), the median patient age was 26.2 years (19.1-65.3). Median percentage of Excessive Body Mass Index Loss was 72.8% (27.4 - 123.8) Gastro-gastric fistulae were seen in 2(5.1%) and hiatal herniae in 16 patients(41%); the gastric pouch was deemed too big in 3 (7.7%). Nine(23%) had esophagitis >LA grade B. PH-Manometry data was available from 37 patients(94.8%). Of those, 15 patients(40.5%) had esophageal hypomotility, a hypotensive lower esophageal sphincter (LES )was seen in 12 patients(32.4%). Increased esophageal acid exposure (>4% pH<4) was found in 6 patients (16.2%), an increased number of reflux episodes (>40) in 17 patients(46%), of which 13 patients(76.5%) had a positive symptom association. Symptoms were diagnosed as functional in 6 patients (15.4%). Conclusion: The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal herniae, hypotensive LES and other esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant to RYGB and the role of pH-manometry in the preoperative bariatric assessment.

Item Type:

Conference or Workshop Item (Poster)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Borbély, Yves Michael; Nett, Philipp C.; Kröll, Dino; Moreno, Peter; Tutuian, Radu and Lenglinger, Johannes

Subjects:

600 Technology > 610 Medicine & health

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

05 Mar 2018 15:14

Last Modified:

05 Mar 2018 15:14

BORIS DOI:

10.7892/boris.94607

URI:

https://boris.unibe.ch/id/eprint/94607

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