Esophageal high-resolution manometry and 24 h pH-impedance monitoring normative values in patients with obesity candidate for bariatric and metabolic surgery.
| Title: | Esophageal high-resolution manometry and 24 h pH-impedance monitoring normative values in patients with obesity candidate for bariatric and metabolic surgery. |
|---|---|
| Authors: | Tolone S; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy. salvatore.tolone@unicampania.it.; Savarino EV; Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.; De Bortoli N; Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; Lucido FS; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Gambardella C; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Brusciano L; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Parisi S; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Del Genio G; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Ruggiero R; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy.; Docimo L; General, Mininvasive, Oncologic and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Via Pansini 5, 80131, Naples, Italy. |
| Source: | Updates in surgery [Updates Surg] 2025 Nov; Vol. 77 (7), pp. 2015-2022. Date of Electronic Publication: 2025 Mar 13. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 101539818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2038-3312 (Electronic) Linking ISSN: 2038131X NLM ISO Abbreviation: Updates Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Milano : Springer-Verlag Italia |
| MeSH Terms: | Manometry*/methods ; Esophageal pH Monitoring*/methods ; Gastroesophageal Reflux*/diagnosis ; Gastroesophageal Reflux*/physiopathology ; Gastroesophageal Reflux*/etiology ; Obesity*/surgery ; Obesity*/complications ; Obesity*/physiopathology ; Esophagus*/physiopathology ; Bariatric Surgery*; Esophagogastric Junction/physiopathology ; Humans ; Female ; Male ; Retrospective Studies ; Adult ; Middle Aged ; Electric Impedance ; Reference Values |
| Abstract: | Obesity is linked to increased risk of gastroesophageal reflux disease (GERD) and esophageal motility disorders, both of which may impact outcomes in metabolic and bariatric surgery (MBS). GERD pathophysiology in obesity includes elevated intraabdominal pressure and altered esophagogastric junction (EGJ) function. High resolution manometry (HRM) and 24-h esophageal pH-impedance (MII-pH) monitoring are vital in evaluating GERD, yet normative values specific to populations with obesity are limited, risking misdiagnosis if lean data are used. This study establishes normative HRM and MII-pH values in asymptomatic individuals with obesity, compared to normal-weight controls, to guide accurate diagnosis and treatment. A retrospective analysis was conducted on asymptomatic patients with obesity (BMI ≥ 30) and normal-weight controls (BMI 20-25) who underwent HRM and MII-pH prior to MBS between 2015 and 2024. Exclusion criteria included GERD symptoms, esophagitis, and prior gastrointestinal surgery. Key HRM parameters (LES pressure, EGJ morphology) and MII-pH metrics (acid exposure time, reflux episodes) were recorded and analyzed. Of the 96 patients with obesity and 25 normal-weight participants, significant differences in HRM and MII-pH results were observed. Individuals with obesity showed increased intra-gastric pressure, gastroesophageal pressure gradient, and higher acid exposure time. While LES pressure and EGJ morphology were similar to controls, participants with obesity exhibited distinct reflux patterns, especially postprandial, suggesting obesity-specific physiological changes. This study establishes normative HRM and MII-pH values for asymptomatic individuals with obesity, highlighting critical differences from normal-weight controls. Obesity-specific diagnostic criteria are essential for accurate GERD diagnosis, particularly for MBS candidates, to improve management and predict potential postoperative complications.; (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Competing interest: None. |
| References: | Gut. 2024 Jan 5;73(2):361-371. (PMID: 37734911); Obes Surg. 2024 Apr;34(4):1075-1085. (PMID: 38438667); J Gastrointest Surg. 2020 Jan;24(1):1-7. (PMID: 31621023); Clin Gastroenterol Hepatol. 2021 Sep;19(9):1976-1978.e1. (PMID: 32890752); Aliment Pharmacol Ther. 2013 Mar;37(5):564-72. (PMID: 23289763); Obes Surg. 2024 Nov;34(11):3963-4096. (PMID: 39320627); Clin Gastroenterol Hepatol. 2013 Apr;11(4):366-72. (PMID: 23142603); Am J Gastroenterol. 2008 Jun;103(6):1355-7. (PMID: 18510602); Clin Gastroenterol Hepatol. 2022 Mar;20(3):e398-e406. (PMID: 33144149); Updates Surg. 2021 Apr;73(2):679-685. (PMID: 33496955); Obes Surg. 2020 May;30(5):1642-1652. (PMID: 32146568); Updates Surg. 2025 Sep;77(5):1603-1625. (PMID: 39419949); Neurogastroenterol Motil. 2024 Apr;36(4):e14750. (PMID: 38297487); World J Gastroenterol. 2015 Mar 14;21(10):3030-4. (PMID: 25780302); Dig Liver Dis. 2006 Apr;38(4):226-32. (PMID: 16480938); Neurogastroenterol Motil. 2021 Jan;33(1):e13954. (PMID: 32715569); Neurogastroenterol Motil. 2021 Jan;33(1):e14058. (PMID: 33373111); Neurogastroenterol Motil. 2021 Jun;33(6):e14009. (PMID: 33094875); Obes Surg. 2023 Jan;33(1):3-14. (PMID: 36336720); Aliment Pharmacol Ther. 2005 Nov 15;22(10):1011-21. (PMID: 16268977); Ann N Y Acad Sci. 2016 Oct;1381(1):98-103. (PMID: 27304195); Gut. 2020 Oct 9;:. (PMID: 33037054); Obes Surg. 2016 Jan;26(1):126-31. (PMID: 26003551); Am J Clin Nutr. 2023 Jan;117(1):141-148. (PMID: 36789933) |
| Contributed Indexing: | Keywords: Bariatric surgery; GERD; High-resolution manometry; pH-impedance monitoring |
| Entry Date(s): | Date Created: 20250313 Date Completed: 20251022 Latest Revision: 20251024 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12540595 |
| DOI: | 10.1007/s13304-025-02167-4 |
| PMID: | 40080355 |
| Database: | MEDLINE |
Journal Article