Factors associated to abnormal distal esophageal exposure to acid and esophagitis in individuals seeking bariatric surgery

Abstract Background Gastroesophageal reflux disease (GERD) impacts choice and outcomes of bariatric surgery. However, a GERD diagnosis based solely on symptoms yields inaccurate results. Objective To determine the factors associated with a positive 24-hour pH-monitoring (pH-test) or esophagitis in patients with severe obesity seeking bariatric surgery. Setting Private practice. Methods Ninety-three patients with severe obesity underwent prospective evaluation for GERD symptoms, body composition, upper gastrointestinal endoscopy, esophageal manometry, and pH-test. Correlation analyses were performed. Results Fifty patients (53.8%) had GERD symptoms, 49 (52.7%) had esophagitis, and 33 (35.5%) had a positive pH-test. Among patients with GERD symptoms, 18% had normal pH-test and no esophagitis, while 34.9% of patients without GERD symptoms had positive pH-test, esophagitis, or both. Factors independently associated with positive pH-test were esophagitis (prevalence ratio [PR]: 3.08, 95% confidence interval [CI]: 1.4–6.9, P  = .006) and defective lower esophageal sphincter (PR: 1.88, 95%CI: 1.09–3.21, P  = .02). Factors independently associated with esophagitis were hiatal hernia (PR: 2.46; 95%CI: 1.6–3.7, P P  = .003), and positive pH-test (PR: 1.82; 95%CI: 1.2–2.7, P  = 0.003). The combined presence of GERD symptoms and esophagitis had a low positive predictive value for a positive pH-test (57%). On the other hand, the absence of both GERD symptoms and esophagitis had a 90% predictive value for a negative pH-test. Conclusions Investigation for GERD before bariatric surgery should consist of routine upper endoscopy and GERD symptom evaluation in all patients. Patients with GERD symptoms and no esophagitis may need a pH-test for GERD diagnosis. Prospective studies are needed to understand significance of GERD diagnosis before bariatric surgery.