TOPLINE 

High-resolution impedance manometry identifies physiologic evidence of gastroesophageal reflux disease (GERD) in many patients with obesity undergoing bariatric surgery evaluation, despite relatively mild or absent reflux symptoms.

METHODOLOGY 

• Obesity can impair esophagogastric junction function and increase GERD risk, but reflux may be underrecognized in this population and may increase the risk for Barrett esophagus.
• Researchers conducted a prospective study of patients with obesity undergoing preoperative evaluation for bariatric surgery to determine whether high-resolution impedance manometry was feasible for characterizing the clinical features and pathophysiology of GERD and esophageal motility.
• Participants completed validated symptom questionnaires, including the GerdQ, Reflux Disease Questionnaire, and Reflux Symptom Index, with higher scores indicating more frequent or severe reflux-related symptoms.
• After fasting for at least 8 hours, all patients underwent upper endoscopy and high-resolution impedance manometry. Esophageal motility was assessed using the Chicago Classification version 4.0, and proven GERD was diagnosed using a study-specific adaptation of Lyon Consensus 2.0 criteria without ambulatory pH or pH-impedance monitoring.
• Impedance reflux (IR) was defined as retrograde bolus movement from the stomach into the esophagus with at least a 50% drop in impedance detected on at least two sensors nearest the lower esophageal sphincter border.

TAKEAWAY 

• Among 62 patients (mean age, 35 years; 56.5% women), 43.5% had proven GERD, whereas only 25.9% reported GERD-like symptoms, suggesting that symptom-based assessment substantially underestimated GERD prevalence.
• Esophagogastric junction disruptions were common, including hiatal hernia (33.9%), a compromised gastroesophageal flap valve (61.3%), and an abnormal esophagogastric junction type (48.4%). Esophageal motility disorders were identified in 8.1% of patients.
• IR was detected in 85.5% of patients, occurring predominantly in the upright position (80.4%) and less frequently in the supine position (54.8%). Patients with IR had higher symptom scores on the GerdQ, Reflux Disease Questionnaire, and Reflux Symptom Index than those without IR.
• Supine IR was associated with a higher prevalence of erosive esophagitis and reduced esophageal body contractility, whereas upright IR was associated with hiatal hernia and an abnormal esophagogastric junction. After adjustment for age, sex, and BMI, supine IR remained independently associated with proven GERD (odds ratio, 3.17; P = .037).

IN PRACTICE 

“[High-resolution impedance manometry]-detected IR is associated with the presence and severity of GERD in patients with obesity and may provide adjunctive physiological information. Nevertheless, IR remains unvalidated against ambulatory reflux monitoring and should not be interpreted as a diagnostic surrogate for reflux burden or a risk stratification tool,” the authors of the study wrote.

SOURCE 

The study was led by Ming-Ching Yuan, Alwayse Health Clinic, New Taipei City, Taiwan. It was published online in Obesity Surgery. 

LIMITATIONS 

The relatively small number of patients may have limited statistical precision and lack the ability to detect small associations. Acid exposure time was not measured using gold-standard pH-impedance or pH monitoring. Long-term GERD outcomes, including Barrett esophagus and esophageal adenocarcinoma, were not evaluated.

DISCLOSURES 

Study funding was not explicitly mentioned. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.