Postobesity Surgery Esophageal Dysfunction: A Combined Cross-Sectional Prevalence Study and Retrospective Analysis.
Adult
Aged
Bariatric Surgery
Cross-Sectional Studies
Deglutition Disorders
/ epidemiology
Esophageal Achalasia
/ epidemiology
Esophageal Motility Disorders
/ epidemiology
Female
Gastrectomy
Gastric Bypass
Humans
Male
Manometry
Middle Aged
Obesity, Morbid
/ surgery
Postoperative Complications
/ epidemiology
Preoperative Period
Pressure
Prevalence
Retrospective Studies
Time Factors
Young Adult
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
20
6
2020
medline:
24
11
2020
entrez:
20
6
2020
Statut:
ppublish
Résumé
Esophageal dysmotility including features of achalasia may develop because of bariatric surgery. However, the prevalence of these complications is unknown. We sought to define the prevalence of dysphagia and major esophageal motility disorders including achalasia after bariatric surgery through a large retrospective database review. Patients with a history of laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass who underwent a diagnostic high-resolution impedance manometry (HRIM) either before or after bariatric surgery across 3 large tertiary referral sites from June 2012 through February 2019 were identified from a procedural database. HRIM studies were interpreted per the Chicago classification v3.0 by a blinded investigator (K.R.). Demographic/clinical features were collected. In addition, patients who underwent bariatric surgery from January 2014 to April 2015 were contacted and administered a validated symptom assessment survey to gauge the overall prevalence of dysphagia in a postbariatric population. A total of 137 patients were identified, including 97 who underwent HRIM after bariatric surgery (laparoscopic sleeve gastrectomy [n = 39, 40.1%]; Roux-en-Y gastric bypass [n = 58, 59.8%]) at a median of 5.84 years (interquartile range 2.1-12.5) postoperatively and 40 preoperative bariatric surgery candidates with medically complicated obesity. A manometric pattern consistent with achalasia was identified in 7 (7.2%) postsurgical patients compared with none in the preoperative group (P = 0.08). We further identified a separate achalasia-like pattern defined by aperistalsis and increased intragastric pressure (postobesity surgery esophageal dysfunction [POSED]) in 5 (5.2%) postsurgical patients vs none found preoperatively (P = 0.14). Achalasia or POSED was associated with postbariatric surgery (12.4% vs 0%, P = 0.02). Increasing time since surgery was independently associated with the development of achalasia (median 12.5 vs 5.8 years, P = 0.02), POSED (median 15.0 vs 5.8 years, P = 0.02) and major motility disorders (6.6 vs 4.9 years, P = 0.01). Furthermore, among 271 postbariatric surgery patients contacted for symptom assessment via survey, the prevalence of dysphagia was 13.7% at a mean 3.9 years after surgery. Postoperative dysphagia is a common long-term complication of bariatric surgery. This is potentially the consequence of a time-dependent association with the development of postoperative esophageal dysmotility, particularly achalasia and POSED. Consequently, esophageal dysmotility may be an important under-recognized complication of bariatric surgery.
Identifiants
pubmed: 32558689
doi: 10.14309/ajg.0000000000000733
pii: 00000434-202010000-00023
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1669-1680Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: A new clinically relevant classification by high-resolution manometry. Gastroenterology 2008;135(5):1526–33.
Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: Lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology 2013;145(5):954–65.
Wehrli NE, Levine MS, Rubesin SE, et al. Secondary achalasia and other esophageal motility disorders after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Am J Roentgenol 2007;189(6):1464–8.
Katzka DA, Farrugia G, Arora AS. Achalasia secondary to neoplasia: A disease with a changing differential diagnosis. Dis Esophagus 2012;25(4):331–6.
Ravi K, Sweetser S, Katzka DA. Pseudoachalasia secondary to bariatric surgery. Dis Esophagus 2016;29(8):992–5.
Khan A, Ren-Fielding C, Traube M. Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding. J Clin Gastroenterol 2011;45(9):775–9.
Chapman R, Rotundo A, Carter N, et al. Laparoscopic Heller's myotomy for achalasia after gastric bypass: A case report. Int J Surg Case Rep 2013;4(4):396–8.
Naef M, Mouton WG, Naef U, et al. Esophageal dysmotility disorders after laparoscopic gastric banding—An underestimated complication. Ann Surg 2011;253(2):285–90.
Shah RN, Izanec JL, Friedel DM, et al. Achalasia presenting after operative and nonoperative trauma. Dig Dis Sci 2004;49(11-12):1818–21.
Ramos AC, Murakami A, Lanzarini EG, et al. Achalasia and laparoscopic gastric bypass. Surg Obes Relat Dis 2009;5(1):132–4.
Cho M, Kaidar-Person O, Szomstein S, et al. Achalasia after vertical banded gastroplasty for morbid obesity: A case report. Surg Laparosc Endosc Percutan Tech 2006;16(3):161–4.
Abu Ghanimeh M, Qasrawi A, Abughanimeh O, et al. Achalasia after bariatric Roux-en-Y gastric bypass surgery reversal. World J Gastroenterol 2017;23(37):6902–6.
Torghabeh MH, Afaneh C, Saif T, et al. Achalasia 5 years following Roux-en-y gastric bypass. J Minim Access Surg 2015;11(3):203–4.
Rubenstein RB. Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year follow-up. Obes Surg 2002;12(3):380–4.
Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg 1999;9(4):390–5.
Cote-Daigneault J, Leclerc P, Joubert J, et al. High prevalence of esophageal dysmotility in asymptomatic obese patients. Can J Gastroenterol Hepatol 2014;28(6):311–4.
Cote-Daigneault J, Poitras P, Rabasa-Lhoret R, et al. Plasma leptin concentrations and esophageal hypomotility in obese patients. Can J Gastroenterol Hepatol 2015;29(1):49–51.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27(2):160–74.
Taft TH, Riehl M, Sodikoff JB, et al. Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol Motil 2016;28(12):1854–60.
Hales CM, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief, No 288. National Center for Health Statistics: Hyattsville, MD, 2017.
American Society for Metabolic, and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2017 (https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers). Accessed July 2019.
Samo S, Carlson DA, Gregory DL, et al. Incidence and prevalence of achalasia in Central Chicago, 2004-2014, since the widespread use of high-resolution manometry. Clin Gastroenterol Hepatol 2017;15(3):366–73.
Duffield JA, Hamer PW, Heddle R, et al. Incidence of achalasia in South Australia based on esophageal manometry findings. Clin Gastroenterol Hepatol 2017;15(3):360–5.
Monrroy H, Cisternas D, Bilder C, et al. The Chicago Classification 3.0 results in more normal findings and fewer hypotensive findings with no difference in other diagnoses. Am J Gastroenterol 2017;112(4):606–12.
Carlson DA, Gyawali CP, Roman S, et al. Esophageal hypervigilance and visceral anxiety are contributors to symptom severity among patients evaluated with high-resolution esophageal manometry. Am J Gastroenterol 2020;115(3):367–75.
Singh S, Sharma AN, Murad MH, et al. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013;11(11):1399–412.e7.
Ravi K, Murray JA, Geno DM, et al. Achalasia and chronic opiate use: Innocent bystanders or associated conditions? Dis Esophagus 2016;29(1):15–21.
Snyder DL, Crowell MD, Horsley-Silva J, et al. Opioid-induced esophageal dysfunction: Differential effects of type and sose. Am J Gastroenterol 2019;114(9):1464–9.
Boules M, Corcelles R, Zelisko A, et al. Achalasia after bariatric surgery. J Laparoendosc Adv Surg Tech A 2016;26(6):428–32.
Aiolfi A, Tornese S, Bonitta G, et al. Management of esophageal achalasia after Roux-en-Y gastric bypass: Narrative review of the literature. Obes Surg 2019;29(5):1632–7.
Browning KN, Fortna SR, Hajnal A. Roux-en-Y gastric bypass reverses the effects of diet-induced obesity to inhibit the responsiveness of central vagal motoneurones. J Physiol (Lond) 2013;591(9):2357–72.
Berthoud HR, Shin AC, Zheng H. Obesity surgery and gut-brain communication. Physiol Behav 2011;105(1):106–19.
Hao Z, Townsend RL, Mumphrey MB, et al. Vagal innervation of intestine contributes to weight loss after Roux-en-Y gastric bypass surgery in rats. Obes Surg 2014;24(12):2145–51.
Ballsmider LA, Vaughn AC, David M, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass alter the gut-brain communication. Neural Plast 2015;2015:601985.
Sioka E, Tzovaras G, Perivoliotis K, et al. Impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Gastroenterol Res Pract 2018;2018:4135813.
Mittal RK, Ren J, McCallum RW, et al. Modulation of feline esophageal contractions by bolus volume and outflow obstruction. Am J Physiol 1990;258(2):15.
Burton PR, Brown W, Laurie C, et al. The effect of laparoscopic adjustable gastric bands on esophageal motility and the gastroesophageal junction: Analysis using high-resolution video manometry. Obes Surg 2009;19(7):905–14.
Gyawali CP, Kushnir VM. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis. Neurogastroenterol Motil 2011;23(6):502–e197.
DeLay K, Austin GL, Menard-Katcher P. Anatomic abnormalities are common potential explanations of manometric esophagogastric junction outflow obstruction. Neurogastroenterol Motil 2016;28(8):1167–71.
Almogy G, Anthone GJ, Crookes PF. Achalasia in the context of morbid obesity: A rare but important association. Obes Surg 2003;13(6):896–900.
Young MT, Phelan MJ, Nguyen NT. A decade analysis of trends and outcomes of male vs female patients who underwent bariatric surgery. J Am Coll Surg 2016;222(3):226–31.
Sweis R, Anggiansah A, Wong T, et al. Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry. Neurogastroenterol Motil 2011;23(6):509–e198.
Misselwitz B, Hollenstein M, Butikofer S, et al. Prospective serial diagnostic study: The effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry. Aliment Pharmacol Ther 2020;51(7):706–18.