Derangement of Esophageal Anatomy and Motility in Morbidly Obese Patients: a Prospective Study Based on High-resolution Impedance Manometry

Abstract Background Morbidly obese patients often suffer from gastroesophageal reflux disease (GERD). High-resolution impedance manometry (HRIM) allows a comprehensive evaluation of esophageal motility and esophagogastric junction (EGJ) morphology and helps to clarify GERD pathophysiology. Objective To evaluate the esophageal function and EGJ anatomy in morbid obesity by HRIM. Setting University Hospital, Taiwan. Methods We consecutively enrolled 57 morbidly obese patients planning to undergo bariatric surgery and 58 healthy volunteers in this prospective study. All patients responded to validated symptom questionnaires and underwent fasting blood tests, HRIM, and esophagogastroduodenoscopy. We compared anthropometric and HRIM parameters between the two groups, and analyzed correlations between the GERD symptom scores and clinical variables in the obese patients. Results The obese patients, comprising 30 males (53%), had a median age of 35 years and body mass index of 40.5 kg/m2. The four-second integrated relaxation pressure (IRP-4s) in the lower esophageal sphincter (LES) was significantly higher in the patients than the volunteers (median: 10.8 versus 5.6 mmHg; p Conclusions The obese patients had a higher LES IRP-4s and higher prevalence of EGJOO and m-HH than the healthy volunteers. The presence of m-HH was strongly associated with EE. The absence of GERD symptoms in morbid obesity was not necessarily suggestive of negative esophagogastroduodenoscopy and HRIM findings, and the discrepancy existed between esophagogastroduodenoscopy and HRIM for diagnosing HH. A comprehensive evaluation of the EGJ anatomy and esophageal function may be considered before bariatric surgery.