Esophageal Manometry and pHmetry Profile in Obese Patients Selected for Bariatric Surgery

Abstract

Background: Obesity is a highly prevalent disease and risk factor for gastroesophageal reflux disease (GERD) which could predispose to esophageal motility disorders. Few studies exist regarding manometric and phmetric findings in patients with obesity who are candidates to bariatric surgery. The objective was to describe the preoperative profile of patients with obesity selected for bariatric surgery. Methods: Retrospective analysis of 338 patients with obesity, subjected to 24 hour-pHmetry with impedance and manometry prior to bariatric surgery between 2006 and 2021. Descriptive and analytical statistics were used for analysis. Results: The mean age and body mass index was 41.94 ± 0.70 years and 38.75 ± 0.37 kg/m2, respectively. GERD symptoms were present in 43.3% (139/321). A 24-hour pHmetry analysis showed a pathologic DeMeester index in 46.7% of patients, of which 64.3% (63/98) were symptomatic. Impedance was abnormal in 53.4%, of which 67% (73/109) were symptomatic. Manometry registered dysmotility in 22.7% (69/304) of patients, a mean lower esophageal sphincter (LES) pressure of 11.93 ± 0.43 mmHg and hypotensive LES in 38.5%. Mean gastric pressure was 9.79 ± 0.33 mmHg after deglutition and only 11.4% (34/299) presented abnormal gastroesophageal gradients. Conclusions: There is a high prevalence of dysmotility and GERD in candidates to bariatric surgery with obesity. Esophageal 24 hour-pHmetry with impedance and manometry should be considered within preoperative tests as pathologic results could guide appropriate procedure selection, at least in symptomatic patients.