Diagnostic Criteria for Gastro-esophageal Reflux Following Sleeve Gastrectomy

Abstract Background Gastro-esophageal reflux disease (GERD) post-sleeve gastrectomy (SG) is a controversial issue and diagnostic dilemma. Strong heterogeneity exists in the assessment of reflux post-SG, and better diagnostic tools are needed to characterize symptomatic reflux. We aimed to determine the discriminant factors of symptomatic reflux and establish diagnostic thresholds for GERD following SG. Materials and Methods Patients post-SG were categorized into asymptomatic and symptomatic cohorts and completed validated symptom questionnaires. All patients underwent stationary esophageal manometry and 24-h ambulatory pH monitoring. Univariate and multivariate analyses were conducted to determine the strongest discriminant factors for GERD. Results Baseline characteristics of the asymptomatic cohort (n = 48) and symptomatic cohort (n = 76) were comparable. The median post-operative duration was 7.3 (14.1) vs 7.5 (10.7) months (p = 0.825). The symptomatic cohort was more female predominant (90.8 vs 72.9%, p = 0.008). Reflux scores were significantly higher in the symptomatic group (36.0 vs 10.5, p = 0.003). Stationary manometry parameters were similar, including hiatus hernia prevalence and impaired esophageal motility. The symptomatic cohort had significantly higher total acid exposure, especially while supine (11.3% vs 0.6%, p < 0.001). Univariate and multivariate regressions delineated reflux score and supine acid exposure as discriminant factors for symptomatic reflux. The thresholds for distinguishing symptomatic reflux are as follows: reflux score of 11.5 (sensitivity 84.0%, specificity 68.2%) and supine acid exposure of 2.65% (sensitivity 67.1%, specificity 70.8%). Conclusion A reflux score of 11.5 or more or supine acid exposure of 2.65% or more should be considered diagnostic in defining symptomatic reflux following SG.

Download Full-text

GERD: Clinical Solutions of Problems in General Practice

Family Medicine ◽

10.30841/2307-5112.6.2016.249566 ◽

2016 ◽

pp. 125-128

Author(s):

Viacheslav Chernobroviy ◽

Serhii Melashchenko ◽

Oleh Ksenchyn

Keyword(s):

Gastric Secretion ◽

Ph Monitoring ◽

Acid Reflux ◽

Acid Exposure ◽

Total Acid ◽

Esophageal Ph ◽

Different Types ◽

Gastric Ph Monitoring ◽

The Difference ◽

Concomitant Hypertension

The objective: To explore the features of acid level and aggravation in stomach and esophagus in patients with isolated GERD, hypertension and their comorbidity. Patients and methods. For this study were selected 4 groups: group of patients with GERD, a group of patients with hypertension, the group of patients with comorbid hypertension and GERD and group without GERD and hypertension (total 78 patients). To all patients were performed 3-channel gastro esophageal pH monitoring. In our case, we conducted a 3-hour version of the survey with standardized provoking breakfast. All patients underwent assessment of gastric secretion by original integrative indicators that reflect basal pH, number of different types of refluxes, duration of alkalization in stomach after meal. Results. GERD patients with hypertension and without are demonstrating an equal number of acid and all (nonacid + acid) reflux which is 18,9 against 19,8 (p>0,05). But the difference between the two groups was that in patients with concomitant hypertension observed longer refluxes 309,3 to 179,1 (p<0,05) and a total acid exposure tends to be prolonged – 25,9 to 20,9 (p>0,05). Our analysis of the state of gastric secretion on the results of 2001 minute intra gastric pH monitoring, showed as expected more intensive acid in both groups of patients with GERD. The most «acidic» patients were GERD patients with hypertension, but compared with similar patients without hypertension, the difference was false due to the relatively small size of the samples. Conclusion. Comorbidity of GERD and hypertension is characterized by severe pathological dysmotility in the lower third of the esophagus, unlike isolated GERD, which affects the increase in acid exposure and susceptibility to long reflux. A factor that may add to burden of GERD in combination with hypertension may be gastric hyperacidity and a clear predisposition to obesity.

Download Full-text

Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02171-3 ◽

2021 ◽

Author(s):

Andrea Balla ◽

Francesca Meoli ◽

Livia Palmieri ◽

Diletta Corallino ◽

Maria Carlotta Sacchi ◽

...

Keyword(s):

Systematic Review ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

De Novo ◽

Ph Monitoring ◽

Meta Analysis ◽

Acid Exposure ◽

Demeester Score ◽

Before And After ◽

Ph Metry

Abstract Purpose Aim of this systematic review is to assess the changes in esophageal motility and acid exposure of the esophagus through esophageal manometry and 24-hours pH-monitoring before and after laparoscopic sleeve gastrectomy (LSG). Methods Articles in which all patients included underwent manometry and/or 24-hours pH-metry or both, before and after LSG, were included. The search was carried out in the PubMed, Embase, Cochrane, and Web of Science databases, revealing overall 13,769 articles. Of these, 9702 were eliminated because they have been found more than once between the searches. Of the remaining 4067 articles, further 4030 were excluded after screening the title and abstract because they did not meet the inclusion criteria. Thirty-seven articles were fully analyzed, and of these, 21 further articles were excluded, finally including 16 articles. Results Fourteen and twelve studies reported manometric and pH-metric data from 402 and 547 patients, respectively. At manometry, a decrease of the lower esophageal sphincter resting pressure after surgery was observed in six articles. At 24-hours pH-metry, a worsening of the DeMeester score and/or of the acid exposure time was observed in nine articles and the de novo gastroesophageal reflux disease (GERD) rate that ranged between 17.8 and 69%. A meta-analysis was not performed due to the heterogeneity of data. Conclusions After LSG a worsening of GERD evaluated by instrumental exams was observed such as high prevalence of de novo GERD. However, to understand the clinical impact of LSG and the burden of GERD over time further long-term studies are necessary.

Download Full-text

Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world

Gut ◽

10.1136/gutjnl-2020-322627 ◽

2020 ◽

pp. gutjnl-2020-322627 ◽

Cited By ~ 2

Author(s):

Daniel Sifrim ◽

Sabine Roman ◽

Edoardo Savarino ◽

Serhat Bor ◽

Albert J Bredenoord ◽

...

Keyword(s):

Regional Differences ◽

Ph Monitoring ◽

Small Sample Size ◽

Small Sample ◽

Acid Exposure ◽

Behavioural Disorders ◽

Total Acid ◽

Consensus Analysis ◽

World Region ◽

Acid Exposure Time

ObjectiveLimitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects.DesignOf 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI).ResultsConsensus analysis was performed in 391 tracings (age 32.7 years, range 18–71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie.ConclusionNormal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings.

Download Full-text