DOCSLIB.ORG

Prevalence of Gastroesophageal Reflux Disease in Obese Patients Eligible for Bariatric Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prevalence of Gastroesophageal Reflux Disease in Obese Patients Eligible for Bariatric Surgery Gastroenterology & Hepatology: Open Access Research Article Open Access Prevalence of gastroesophageal reflux disease in obese patients eligible for bariatric surgery Abstract Volume 11 Issue 4 - 2020 Objective: To determine the prevalence and characteristics of gastroesophageal reflux disease (GERD) in obese patients at the Mário Covas State Hospital (Hospital Estadual Robin Mauricio Yance Hurtado,¹ Thiago Mário Covas) who are candidates to bariatric surgery through complementary examinations. Ferreira de Souza,² Manoel dos Passos Galvão Neto,3 Eduardo Grecco,4 Sergio A Methods: One hundred and fifty obese patients eligible for bariatric surgery were evaluated 5 5 using three diagnostic methods for GERD (questionnaire, upper gastrointestinal endoscopy Barrichello Junior, Ethel Zimberg Chehter [UGE], and 24-hour esophageal pH monitoring [EPM]). Ambulatory esophageal manometry ¹Department of Endoscopy, Faculty of Medicine of ABC, Brazil ²Department of Endoscopy, School of Medicine of the (AEM) complemented the anatomical-physiological study of GERD. University of São Paulo (FMUSP), Brazil Results: The results of 24-hour EPM indicated that the prevalence of GERD in the study ³Department of Surgery, Faculty of Medicine of ABC, Brazil 4 population was 42.7%. Similar prevalence rates (65% and 54.2%) were found in other Department of Endoscopy, Faculty of Medicine of ABC, Brazil 5 studies. Department of Clinical Gastroenterology, Faculty of Medicine of ABC, Brazil The questionnaire results were not significantly correlated with the results of complementary examinations and body mass index. UGE results showed that the prevalence of hiatal hernia Correspondence: Robin Mauricio Yance Hurtado, was low (13%). The prevalence of erosive reflux esophagitis (ERE) was significantly Departamento de Gastroenterologia Clínica da Faculdade de higher in the study population (38.0%) than in the general population (11.8–15.5%). No Medicina do ABC. Avenida Príncipe de Gales, 821. Santo André, acid reflux-related complications were observed. The results of AEM showed that 60% São Paulo, Brazil, CEP09060-600, Tel 55 11 976059294, of patients had esophageal motility changes. Transient lower esophageal sphincter (LES) Email relaxation was the most common motility disorder and was significantly associated with Received: July 11, 2020 | Published: July 28, 2020 ERE (p=0.010) and distal gastroesophageal reflux (GER) (p=0.038). Body mass index was significantly correlated with distal GER p( =0.017) on EPM. Conclusion: The prevalence of GERD was high in obese patients eligible for bariatric surgery. Erosive reflux esophagitis and Hypotonic LES were significantly associated with acid reflux. Typical reflux symptoms were not useful diagnostic indicators of GERD in this population. Keywords: obesity, gastroesophageal reflux, bariatric surgery, bariatric endoscopy, esophageal motility Abbreviations: GER, gastroesophageal reflux; GERD, However, there are controversies among the authors regarding the real gastroesophageal reflux disease; UGE, upper gastrointestinal magnitude of this association, between obesity and GERD. This work endoscopy; EPM, 24-hour esophageal pH monitoring; AEM, proposes to evaluate the profile of GERD in morbidly obese patients ambulatory esophageal manometry; ERE; erosive reflux esophagitis, through complementary exams and, thus, to identify variables and risk LES, lower esophageal sphincter; HEMC, mário covas state hospital factors that may participate in the pathophysiological mechanisms of this disease in obese people, data that served as a basis for future Introduction research on this subject. Obesity is a chronic nutritional disorder that is characterized by an Materials and methods excessive accumulation of body fat, which is influenced by lifestyle and socio-cultural factors, especially in emerging and first world Study design countries. In these countries the prevalence of gastroesophageal reflux This prospective, non-randomized, cross-sectional, single-center disease (GERD), as well as obesity, has progressively increased, as cohort study was carried out at the Digestive Endoscopy Service has been shown by some studies, with GERD rates up to 20%.1 and Functional Assessment Service of the Esophagus of HEMC in The clinical presentation of GERD in obese patients is perhaps 150 obese patients who were candidates for bariatric surgery at the one of the most controversial issues, as its diagnosis is influenced Digestive Surgery Service of HEMC. All patients eligible for bariatric by subjective, cultural, personal and psychological factors. Some surgery had either a body mass index (BMI) ≥40kg/m² or BMI ≥35kg/ authors propose that obesity itself is a risk factor for the development m² associated with comorbidities. Other inclusion criteria were age 18 of GERD, but this relationship remains controversial with regard to 65years, the ability to understand and answer the questionnaire on to the real impact of obesity on esophageal physiology and the GERD symptoms and quality of life (GERDS-QoL) (Annex A), and consequences on GERD, including esophagitis, Barrett’s esophagus no contraindication to complementary examinations. (BE) and adenocarcinoma in obese.2 The exclusion criteria were patients who underwent anti-reflux The changes caused by obesity in the physiology of the digestive surgery, anatomical changes in the esophagus and stomach, pregnant system, such as increased intra-abdominal pressure, lead us to or lactating patients, disabling psychiatric illnesses, and subjects consider that this nutritional disorder favors the development GERD undergoing other clinical assessments. and that the vast majority of obese patients are carrier of this disorder. Submit Manuscript | http://medcraveonline.com Gastroenterol Hepatol Open Access. 2020;11(4):134‒139. 134 ©2020 Hurtado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Copyright: Prevalence of gastroesophageal reflux disease in obese patients eligible for bariatric surgery ©2020 Hurtado et al. 135 Techniques, tests, and examinations criterion for diagnosing GERD was the identification of typical symptoms (heartburn and retrosternal burning) lasting 4 to 8weeks, Patients underwent the following complementary examinations with a minimum frequency of twice a week, according to the before bariatric surgery: completion of the GERDS-QoL questionnaire guidelines of the First Brazilian Consensus on Gastroesophageal (Table 1), UGE, AEM, and 24-hour esophageal pH monitoring. To Reflux Disease.3 The degree of obesity was determined using the BMI improve data reliability, patients using anti-reflux drugs (proton pump classification adopted by the WHO by dividing body mass (Kg) by the inhibitors and H1 blockers) were instructed to discontinue treatment square height (m2).4 for 3weeks before answering the questionnaire and undergoing UGE, manometry, and 24-hour esophageal pH monitoring. UGE: This examination was performed under conscious sedation, according to the protocol of the HEMC anesthesia team. The Los Instruments for data collection and operational Angeles classification was used to indicate the degree of ERE.5 HH definition of variables was considered when the gastric esophageal transition (GET) was 6 The research protocol was approved by the Research Ethics 2cm or more above the diaphragmatic hiatus. Committee of the School of Medicine of the University of ABC AEM: This examination was performed using a polygraph and an (FMABC) under Protocol No. 34627614.4.0000.0082. Patients and eight-channel silicone catheter (four radial and four longitudinal parents or legal guardians were informed about the study protocols channels) in a perfusion system to identify the anatomical parameters and signed informed consent. necessary to guide the position of pH electrodes and assess esophageal motility changes. The physiological and pathological criteria of this Clinical data and anamnesis: Interviews in which the patient 7 completed the GERDS-QoL questionnaire (Table A). The clinical examination were established by Nasi et al. (Figure 1). Figure 1 ambulatory esophageal manometry examination report Citation: Hurtado RMY, Souza TFD, Neto MDPG, et al. Prevalence of gastroesophageal reflux disease in obese patients eligible for bariatric surgery. Gastroenterol Hepatol Open Access. 2020;11(4):134‒139. DOI: 10.15406/ghoa.2020.11.00429 Copyright: Prevalence of gastroesophageal reflux disease in obese patients eligible for bariatric surgery ©2020 Hurtado et al. 136 EPM: Monitoring was performed using catheters with one or two physiological and pathological criteria used in this examination were antimony electrodes to detect pH changes in acid reflux, according established by DeMeester8 (Figure 2). to the variation in H+ concentration in the distal esophagus. The Figure 2 24-Hour esophageal ph monitoring examination reports Statistical analyses (N=106, 70.60%), and one third (44, 29.3%) had either a BMI <40kg/ m2 or a BMI >35kg/m2 together with obesity-related comorbidities. SPSS Statistics for Windows version 16 (SPSS Inc., Chicago, IL, GERDS-QoL results (Table A) indicated that 79 patients (52.7%) USA) was used for all statistical analyses. The data were subjected presented with GERD. The level of acceptance of symptoms was to descriptive and inferential statistical analyses. For the descriptive considered satisfactory because the majority of responses were
Load more

Recommended publications
  • EGD - If You Have Symptoms That Do Not Go Away, Like Heartburn, Vomiting Or Belly Pain, You May Need an Upper Endoscopy
    EGD - if you have symptoms that do not go away, like heartburn, vomiting or belly pain, you may need an upper endoscopy. An upper endoscopy is also known as an esophagogastroduodenoscopy (EGD). It is a test that enables doctors to examine the upper digestive tract, which includes the: • Esophagus (“food tube” that connects the mouth to the stomach) • Stomach • Duodenum (upper part of the small intestine) An EGD uses an endoscope, which is a long, flexible tube with a camera and light at its tip. The doctor carefully guides the endoscope through the mouth and down the throat to view the upper digestive tract to view images of the digestive tract and can take color photos of specific areas. They may take a biopsy (tissue sample) of abnormal tissue, such as growths, irritations or ulcers, which are sores in the intestine’s lining. Esophageal dilation - Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure while your are sedated during your EGD. Flexible Sigmoidoscopy - A sigmoidoscope is a slender, flexible tube with a light and a very small video camera at the end of it. It is shorter than a colonoscope and is only able to evaluate the lower third of the colon. This allows a look at the inside of the rectum and lower part of the colon for cancer or polyps. Before the test, you will need to take an enema or other prep to clean out the lower colon, but a full cleansing solution is not needed as in colonoscopy.
    [Show full text]
  • Gastroenterology, Nutrition and Organ Transplantation
    Gastroenterology, Nutrition and Organ Transplantation MEDICAL POLICY GROUP Co-chairs Katherine Dallow, MD, MPH • Vice President • Clinical Programs and Strategy Desiree Otenti, ANP, MPH, Senior Director • Medical Policy Administration October 27th 2020 12-2 pm Conference call only. Please email [email protected] for more information. Invited: Katherine Dallow, MD, MPH, co-chair (Medical Policy Administration), Desiree Otenti, ANP, co- chair, (Medical Policy Administration); Grace Baker, MSW, LCSW, (Medical Policy Administration); Laura Barry, RN, BSN, (Medical Policy Administration); Craig Haug, MD, (Surgery); Thomas Hawkins, MD, (Internal Medicine); Kenneth Duckworth, MD, (Psychiatry); Peter Lakin, R.Ph, (Pharmacy Operations); Thomas Kowalski, R.Ph, (Clinical Pharmacy) Invited Physician Guest(s): Representatives from the Massachusetts Society of Gastroenterology; Massachusetts Society of Organ Transplantation Policies with Upcoming Coverage Updates Transcatheter Arterial Effective 12/1/2020: Chemoembolization to Treat New investigational indications described for TACE as part of combination Primary or Metastatic Liver therapy (with radiofrequency ablation) for resectable or unresectable Malignancies (634) hepatocellular carcinoma. Policies with Coverage Updates in the Past 12 Months AIM guideline: Effective August 16, 2020: Advanced Vascular Imaging Aneurysm of the abdominal aorta or iliac arteries (930) • Added new indication for asymptomatic enlargement by imaging • Clarified surveillance intervals for stable aneurysms as follows: o Treated
    [Show full text]
  • Esophageal Functional Disorders in the Pre-Operatory Evaluation of Bariatric Surgery
    AG-2020-213 ORIGINAL ARTICLE doi.org/10.1590/S0004-2803.202100000-34 Esophageal functional disorders in the pre-operatory evaluation of bariatric surgery Eponina Maria de Oliveira LEMME1, Angela Cerqueira ALVARIZ2 and Guilherme Lemos Cotta PEREIRA3 Received: 28 September 2020 Accepted: 11 December 2020 ABSTRACT – Background – Obesity is an independent risk factor for esophageal symptoms, gastroesophageal reflux disease (GERD), and motor ab- normalities. When contemplating bariatric surgery, patients with obesity type III undergo esophagogastroduodenoscopy (EGD) and also esophageal manometry (EMN), and prolonged pHmetry (PHM) as part of their pre-operative evaluation. Objective – Description of endoscopy, manometry and pHmetry findings in patients with obesity type III preparing for bariatric surgery, and correlation of these findings with the presence of typical GERD symptoms. Methods – Retrospective study in which clinical symptoms of GERD were assessed, focusing on the presence of heartburn and regurgitation. All patients underwent EMN, PHM and most of them EGD. Results – 114 patients (93 females–81%), average age 36 years old, average BMI of 45.3, were studied. Typical GERD symptoms were referred by 43 (38%) patients while 71 (62%) were asymptomatic. Eighty two patients (72% of total) underwent EGD and 36 (42%) evidenced esophageal abnormalities. Among the abnormal findings, hiatal hernia was seen in 36%, erosive esophagitis (EE) in 36%, and HH+EE in 28%. An abnormal EMN was recorded in 51/114 patients (45%). The main abnormality was a hypotensive lower esophageal sphincter (LES) in 32%, followed by ineffective esophageal motility in 25%, nutcracker esophagus in 19%, IEM + hypotensive LES in 10%, intra-thoracic LES (6%), hypertensive LES (4%), aperistalsis (2%) and achalasia (2%).
    [Show full text]
  • Pediatric Gastroesophageal Reflux Clinical Practice Guidelines 499
    Journal of Pediatric Gastroenterology and Nutrition 49:498–547 # 2009 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Co-Chairs: ÃYvan Vandenplas and yColin D. Rudolph Committee Members: zCarlo Di Lorenzo, §Eric Hassall, jjGregory Liptak, ôLynnette Mazur, #Judith Sondheimer, ÃÃAnnamaria Staiano, yyMichael Thomson, zzGigi Veereman-Wauters, and §§Tobias G. Wenzl ÃUZ Brussel Kinderen, Brussels, Belgium, {Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA, {Division of Pediatric Gastroenterology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA, §Division of Gastroenterology, Department of Pediatrics, British Columbia Children’s Hospital/University of British Columbia, Vancouver, BC, Canada, jjDepartment of Pediatrics, Upstate Medical University, Syracuse, NY, USA, ôDepartment of Pediatrics, University of Texas Health Sciences Center Houston and Shriners Hospital for Children, Houston, TX, USA, #Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA, ÃÃDepartment of Pediatrics, University of Naples
    [Show full text]
  • Selecthealth Medical Policies Gastroenterology Policies
    SelectHealth Medical Policies Gastroenterology Policies Table of Contents Policy Title Policy Last Number Revised Bravo PH Monitoring Probe 200 12/19/09 Colonic Manometry 619 10/02/17 Computed Tomography Colonography (CTC) Virtual Colonoscopy 399 04/22/10 DNA Analysis of Stool for Colon Cancer Screening (Cologuard) 260 09/16/21 Drug Monitoring in Inflammatory Bowel Disease 532 02/26/20 Endoscopic Ultrasonography (EUS) 118 05/31/16 Formulas And Other Enteral Nutrition 534 12/21/20 Gastric Pacing/Gastric Electrical Stimulation (GES) 585 05/27/20 Genetic Testing: CA 19-9 Testing 331 06/30/16 IB-Stim 637 10/14/19 Injectable Bulking Agents In The Treatment Of Fecal Incontinence 531 06/10/15 In-Vivo Detection of Mucosal Lesions with Endoscopy 574 10/15/15 LINX System For The Management of Gerd 520 01/28/13 Peroral Endoscopic Myotomy (POEM) for the Treatment of 588 06/06/16 Esophageal Achlasia Pillcam ESO (Esophagus) 278 08/18/08 Prognostic Serogenetic Testing for Crohn’s Disease (Prometheus® Monitr™) 484 04/06/21 Serologic Testing For Diagnosis of Inflammatory Bowel Disease 175 04/06/21 Serum Testing For Hepatic Fibrosis (Fibrospect II, The Fibrotest, and The 274 08/28/20 HCV-Fibrosure Test) Transcutaneous Electrical Stimulation Devices For Nausea and Vomiting 199 12/27/09 Transendoscopic Anti-Reflux Procedures 198 08/06/10 By accessing and/or downloading SelectHealth policies, you automatically agree to the Medical and Coding/ Reimbursement Policy Manual Terms and Conditions. Gastroenterology Policies, Continued MEDICAL POLICY BRAVO PH MONITORING PROBE Policy # 200 Implementation Date: 10/10/03 Review Dates: 11/18/04, 9/7/05, 12/21/06, 12/20/07, 12/18/08, 12/16/10, 12/15/11, 4/12/12, 6/20/13, 4/17/14, 5/7/15, 4/14/16, 4/27/17, 6/24/18, 4/23/19, 4/6/20 Revision Dates: 12/19/09 Disclaimer: 1.
    [Show full text]
  • Laparoscopic Antireflux Surgery After Roux-En-Y Gastric Bypass for Obesity
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Biblioteca Digital da Produção Intelectual da Universidade de São Paulo (BDPI/USP) Universidade de São Paulo Biblioteca Digital da Produção Intelectual - BDPI Sem comunidade Scielo 2012 Modified Nissen fundoplication: laparoscopic antireflux surgery after Roux-en-Y gastric bypass for obesity Clinics,v.67,n.5,p.531-533,2012 http://www.producao.usp.br/handle/BDPI/40389 Downloaded from: Biblioteca Digital da Produção Intelectual - BDPI, Universidade de São Paulo CLINICS 2012;67(5):531-533 DOI:10.6061/clinics/2012(05)23 CASE REPORT Modified Nissen fundoplication: laparoscopic anti- reflux surgery after Roux-en-Y gastric bypass for obesity Nilton T Kawahara,I Clarissa Alster,I Fauze Maluf-Filho,II Wilson Polara,III Guilherme M. Campos,IV Luiz Francisco Poli-de-Figueiredo (in memoriam)I I Faculdade de Medicina da Universidade de Sa˜ o Paulo, (FMUSP), Department of Surgical Technique, Sa˜ o Paulo/SP, Brazil. II Faculdade de Medicina da Universidade de Sa˜ o Paulo, (FMUSP), Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Sa˜ o Paulo/SP, Brazil. III Sı´rio Libaneˆ s Hospital, Department of Oncology Surgery, Sao Paulo/SP, Brazil. IV University of Wisconsin School of Medicine and Public Health, Department of Surgery, Wisconsin/USA. Email: [email protected] Tel.: 55 11 5585 9119 CASE DESCRIPTION (normal ,14.72, 95th percentile). Manometry showed a lower esophageal sphincter pressure (LES) of 9 mmHg (normal A 46-year-old white woman presented to the clinic in range from 14.3 to 34.5 mmHg), and the contraction amplitude September 2009 with intermittent abdominal epigastric pain of the proximal and middle region was greater than 30 mmHg accompanied by nausea, heartburn and frequent crises of (50.6 mmHg).
    [Show full text]
  • 24-Hour Esophageal Ph Monitoring Prep Instructions Procedure Checklist
    24-Hour Esophageal pH Monitoring Prep Instructions Patient Name: Gastroenterologist: Date/Time of Procedure: _______________________ Arrive: ________________ Report to Main Building, 2nd Floor, Room M2210 Hospital Address: 3800 Reservoir Rd. N.W., Washington, D.C. 20007 Instructions: Attached are detailed instructions as well as a checklist to help you prepare for your procedure. Please read the instructions in their entirety and use the checklist as a guide to help ensure a complete prep for your procedure. Procedure Checklist Before you start: If you have questions concerning your current medications, call 202-444-8541 and select option 4 to speak to a nurse. You may need to make arrangements for a responsible adult or medical transport to drive you home after your procedure. Please see FAQs or call 202-444-8541 and select option 4 to speak to a nurse. Stop medications used for treating reflux and for treating stomach acid problems unless you are told to continue these medications by your physician. o Some medications should be stopped for 1 week prior to the test. These include: Prilosec (omeprazole), Nexium (esomeprazole), Aciphex (rabeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Zegarid (immediate release omeprazole). o Some medications need to be stopped for 2 days before the test. These include: Zantac (Randitidine), Tagamet (Cimetidine), Axid (Nizatidine), Pepcid (Famotidine). Note that your physician may want you to continue these medications up to and during the test to determine how effective they are in suppressing acid production. If so, please take these medications at your regular time of the day prior to the test and the morning of the test (with a little bit of water) Day of your procedure: Do not eat or drink anything after midnight.
    [Show full text]
  • Gastroesophageal Reflux
    S218 Jornal de Pediatria - Vol. 76, Supl.2, 2000 0021-7557/00/76-Supl.2/S218 Jornal de Pediatria Copyright© 2000 by Sociedade Brasileira de Pediatria REVIEW ARTICLE Gastroesophageal reflux Rocksane C. Norton1, Francisco J. Penna2 Abstract Objective: to discuss clinical, diagnostic and therapeutic aspects of gastroesophageal reflux. Method: we accomplished a literature review of the last 30 years, by means of Lilacs and Medline databases. Results: the gastroesophageal reflux is one of the most frequent causes of medical appointments with pediatric gastroenterologists. It represents a benign condition, characterized by regurgitations that can be resolved with general measures. Medical management with prokinetics and antacid agents controls clinical manifestations and prevents complications. Fundoplication is reserved to a minority of cases. Comments: some aspects of the clinical treatment have to be emphasized. Thickened/Solid diet and erect posture must be always recommended. Cisapride, the most commonly employed prokinetic agent, may prolong ventricular repolarization. Other prokinetic agents should be used in children. Bronchospasm or clinical manifestations of esophagitis indicate the use of antacid drugs. J Pediatr (Rio J) 2000; 76 (Supl.2): S218-224: gastroesophageal reflux, child. Introduction Gastroesophageal reflux (GER) can be defined as the not compromising the child’s growth and development. On retrograde and repetitive flux of gastric content for the the other hand, the pathological reflux presents clinical esophagus. It is frequent in children, and usually presents a repercussions, such as growth deficit, abdominal pain, benign evolution. It is characterized by the presence of irritability, digestive hemorrhages, bronchospasm, repeated regurgitations. Besides abdominal pain and intestinal pneumonia, or otorhinolaryngological complications, which constipation, it constitutes one of the main reasons of require capacity on the diagnosis and attention on the appointments with pediatric gastroenterologists.
    [Show full text]
  • Gastroesophageal Motility and Reflux Following Bariatric Surgery for the Treatment Of
    Gastroesophageal Motility and Reflux Following Bariatric Surgery for the Treatment of Severe Obesity by Caroline Sheppard A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Surgery University of Alberta © Caroline Sheppard, 2017 Abstract Obesity is a recognized complex chronic disease that impacts millions of people globally. Bariatric surgery is the only evidence-based method for sustainable weight loss and resolution of obesity associated morbidities. However, complications can occur after surgery, in particular gastroesophageal reflux (GERD) and esophageal motility disorders after laparoscopic sleeve gastrectomy (LSG). Existing literature describes many contradictory causes for symptoms of GERD and investigators remain uncertain whether reflux following LSG is present, and if present, whether it is alkaline/acidic, and what precise pathophysiology leads to these symptoms. In fact, patients are empirically treated with anti-secretory therapy based on heartburn symptoms. In addition, while literature points to higher rates of esophageal motility disorders in the obese and bariatric population, the relationship with body mass index (BMI) is poorly understood. A case of a patient with severe dysmotility syndrome and reflux symptoms initiated this thesis. The objective of this thesis was to determine the relationships between bariatric surgery and gastroesophageal motility and reflux. The hypothesis was that the anatomical changes after bariatric surgery created disturbances in esophageal and gastric motility causing non-acid gastroesophageal reflux and related symptoms. This thesis began by exploring this hypothesis by performing a chart review of surgical patients at the Edmonton Adult Bariatric Specialty Clinic to determine the prevalence of postoperatively treated or identified reflux and esophageal motility disorders.
    [Show full text]
  • DIGESTIVE DISEASE CENTER University Hospital of Brooklyn • Long Island College Hospital • SUNY Downstate Bay Ridge
    SUNY DowNState MeDical ceNter DIGESTIVE DISEASE CENTER University Hospital of Brooklyn • long island college Hospital • SUNY Downstate Bay ridge 2012-13 comPreHensiVe Gi serVices GENERAL ADVANCED ENDOSCOPY The Digestive Disease Center at SUNY Downstate GASTROENTEROLOGY Endoscopy allows for direct internal examination and much more accurate diagnosis and treatment of digestive and liver Medical Center provides expertise in all aspects of problems, without invasive surgical procedures. At our state-of-the-art Endoscopy Center, patients have access to virtually gastrointestinal disease management, including: In addition to routine colorectal screenings, we provide every available endoscopic, manometric and treatment option—plus some investigational diagnostic and therapeutic diagnoses and treatment for a wide range of medical procedures not available elsewhere. Medical Director Frank Gress is one of the pioneers of endoscopic ultrasound and General Gastroenterology problems related to the stomach, intestinal tract, biliary literally wrote a textbook on the procedure. tract, gallbladder, bowel and liver, including: Colorectal Cancer Screening Full range of advanced diagnostic and therapeutic endoscopic services: I Colon polyps and colon cancer Advanced Endoscopy I Endoscopic retrograde cholangiopancreatography (ERCP). I Constipation I Sphincter of Oddi manometry (SOD). Pancreaticobiliary Disease I GI bleeding I Endoscopic ultrasound with fine-needle aspiration (EUS FNA). Esophageal and Motility Disorders I Hemorrhoids I I Colonic stents, esophageal stents, small bowel stents and other stent placement Inflammatory Bowel Disease Irritable bowel syndrome for palliative purposes. I Hepatitis & Other Liver Diseases Chronic diarrheal disorder I Small bowel enteroscopy to evaluate gastrointestinal bleeding. I Peptic ulcer disease Pediatric Gastroenterology I Video capsule endoscopy. I Rectal incontinence I Gastrointestinal Radiology EMR, BARRx and photodynamic therapy.
    [Show full text]
  • Diagnosis and Treatment of Gastro-Oesophageal Reflux
    82 Archives ofDisease in Childhood 1995; 73: 82-86 PERSONAL PRACTICE Arch Dis Child: first published as 10.1136/adc.73.1.82 on 1 July 1995. Downloaded from Diagnosis and treatment of gastro-oesophageal reflux A E M Davies, B K Sandhu Gastro-oesophageal reflux (GOR) is defined as quency of the vomiting if presents and a the involuntary passage of gastric contents into detailed dietary assessment is essential. the oesophagus, and is a common cause of Systematic inquiry should also establish the morbidity in childhood. GOR is an occasional presence of associated failure to thrive, and physiological event in normal adults and child- respiratory or neurological symptoms. On ren,1 2 but becomes pathological when its examination, an assessment should be made of intensity or frequency increases or when com- nutritional status, respiratory signs, and neuro- plications arise (for example, oesophagitis, fail- developmental milestones, searching also for ure to thrive). GOR may be primary (due to signs of the causes of secondary GOR. anatomical or physiological abnormalities) or secondary to other diseases such as urinary tract infection, metabolic disorders, food Investigations allergy, etc (see table 1). The increasing avail- In those patients with uncomplicated primary ability of lower oesophageal pH monitoring, GOR, few initial investigations are needed, paediatric endoscopic skills, and newer more although we routinely check a urine culture to effective pharmacological agents has led to a exclude urinary tract infection. We check a full greater awareness of the range of symptoms blood count, and faecal occult blood tests if attributable to gastro-oesophageal reflux disease occult gastrointestinal blood loss is suspected (GORD), and the need for a structured clinically.
    [Show full text]
  • Analyzing the Effect of Laparoscopy Duration Time on Peroperative Gastroesophageal Reflux
    Turkish Journal of Medical Sciences Turk J Med Sci (2019) 49: 639-643 http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Research Article doi:10.3906/sag-1803-176 Analyzing the effect of laparoscopy duration time on peroperative gastroesophageal reflux 1, 1 1 Gökhan Berktuğ BAHADIR *, Hakan TAŞKINLAR , Caner İSBİR , 1 1 2 1 İsa KILLI , Dilek YÜNLÜEL , Ülkü ÇÖMELEKOĞLU , Ali NAYCI 1 Department of Pediatric Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey 2 Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Turkey Received: 21.03.2018 Accepted/Published Online: 20.02.2019 Final Version: 18.04.2019 Background/aim: Intraabdominal pressure (IAP) is one of the main reasons for gastroesophageal reflux (GER). This study investigates whether IAP during laparoscopic surgery leads to GER in a time-dependent manner. Materials and methods: In a laparoscopy model, 15 mmHg IAP was created in 8 Wistar albino rats in the Trendelenburg position (TP). A 5 mm laparotomy was performed in the left lower abdominal region, and a 6 Fr catheter was placed intraabdominally. Air was insufflated into the abdominal cavity, and the pressure was kept constant at 15 mmHg. Esophageal pH alterations were measured by pH sticks for 4 h every 30 min. Results: The basal median esophageal pH value was 9 (8–10), the value after placing the catheter was 9 (7–10) (P = 0.47), and the median pH value after placing the subjects in TP was 9 (8–10) (P = 0.70). In our experimental model, esophageal pH values were found to decrease significantly at the 150th minute in TP and at 15 mmHg IAP (P < 0.05).
    [Show full text]