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GERD common among obese patients undergoing bariatric surgery

07 Jun 2019

Gastro-oesophageal reflux disease (GERD) is common among obese patients qualified for bariatric surgery, underscoring the need for preoperative endoscopic assessment, a recent study has shown.

Researchers enrolled 242 consecutive obese patients (mean age, 37.8±11.8 years; 53.7 percent female) undergoing routine oesophagogastroduodenoscopy. Prior to the operation, participants were made to complete the Nocturnal Symptom Severity Impact (N-GSSIQ) and the GERD questionnaire (GERDQ).

GERD, defined as GERDQ score 8, the presence of erosive oesophagitis (EE) or daily use of proton pump inhibitors, was identified in 62.4 percent of the participants. Thirty-one more patients (12.8 percent) had silent or inconspicuous, yet important, GERD.

Excluding 49 participants without erosive disease, researchers found that EE was significantly more common in patients with GERDQ score 8 (70.6 percent vs 27.2 percent; p<0.001), with hiatal hernia (69.7 percent vs 36.9 percent; p<0.001) and with severe nocturnal GER symptoms (65.6 percent vs 37.9 percent; p=0.004).

Multivariate logistic regression analysis confirmed that GERDQ 8 (odds ratio [OR], 6.3, 95 percent CI, 3.0–13.1) and the presence of hiatal hernia (OR, 4.2, 1.6–10.7) were significantly predictive of EE. The same was true for having an abnormal Hill grade (OR, 2.7, 1.4–5.4) and tobacco use (OR, 2.5, 1.2–4.9).

However, a pre-endoscopic assessment combining GERDQ and the presence of nocturnal reflux symptoms yielded high specificity (90 percent), but a sensitivity value of only 20.7 percent. The negative and positive predictive values were 68.9 percent and 51.5 percent, respectively. This highlights the need for preoperative endoscopic assessment, said researchers.

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