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Background: A current management dilemma in laparoscopic sleeve gastrectomy (LSG) patients is the development of significant gastroesophageal reflux symptoms after surgery. Treatment is typically directed towards reducing acid reflux despite the surgical removal of parietal cell mass. In contrast, laparoscopic Roux-en-Y gastric bypass (LRYGB) has been known to reduce or resolve preoperative reflux symptoms. The objective of this study was to determine the incidence of preoperative and postoperative reflux of LSG and LRYGB patients, and review reflux treatment type and response., Methods: A retrospective chart review was performed for patients undergoing either LSG or LRYGB between January 2010 and December 2012 as part of the Weight Wise program, Royal Alexandra Hospital, Edmonton, Canada., Results: A total of 387 cases were included in our review. We observed a significant reduction in BMI postoperatively for both LSG and LRYGB groups (p < 0.001). Between surgical groups, preoperative proton-pump inhibitor (PPI) use was not significantly different; however, at 1 month (p < 0.05) to 1-2 years (p < 0.001), there was significantly increased PPI use in patients after LSG in comparison to LRYGB. Of the LSG patients that continued their PPI treatment after surgery, 58% increased, 42% continued the same, and 0% decreased their dose 1 year after surgery., Conclusions: Reflux symptoms are significantly increased after LSG in comparison to LRYGB patients. In addition, LSG patients more frequently require initiation of reflux treatment after surgery than that of LRYGB patients. Patients reported postoperative reflux symptom relief with acid-suppressant therapies.

Background: Wireless capsule pH-metry (WC) is better tolerated than standard nasal pH catheter (SC), but endoscopic placement is expensive., Aims: to confirm that non-endoscopic peroral manometric placement of WC is as effective and better tolerated than SC and to perform a cost analysis of the available esophageal pH-metry methods., Methods: Randomized trial at 2 centers. Patients referred for esophageal pH testing were randomly assigned to WC with unsedated peroral placement or SC after esophageal manometry (ESM). Primary outcome was overall discomfort with pH-metry. Costs of 3 different pH-metry strategies were analyzed: 1) ESM + SC, 2) ESM + WC and 3) endoscopically placed WC (EGD + WC) using publicly funded health care system perspective., Results: 86 patients (mean age 51 ± 2 years, 71% female) were enrolled. Overall discomfort score was less in WC than in SC patients (26 ± 4 mm vs 39 ± 4 mm VAS, respectively, p = 0.012) but there were no significant group differences in throat, chest, or overall discomfort during placement. Overall failure rate was 7% in the SC group vs 12% in the WC group (p = 0.71). Per patient costs ($Canadian) were $1475 for EGD + WC, $1014 for ESM + WC, and $906 for ESM + SC. Decreasing the failure rate of ESM + WC from 12% to 5% decreased the cost of ESM + WC to $991. The ESM + SC and ESM + WC strategies became equivalent when the cost of the WC device was dropped from $292 to $193., Conclusions: Unsedated peroral WC insertion is better tolerated than SC pH-metry both overall and during placement. Although WC is more costly, the extra expense is partially offset when the higher patient and caregiver time costs of SC are considered., Trial Registration: Clinicaltrials.gov Identifier NCT01364610.

In patients with gastroesophageal reflux disease (GERD), esophageal symptoms are traditionally diagnosed by monitoring the contact time between the reflux content and the esophagus using multichannel intraluminal impedance and pH (MII-pH) catheters. However, esophageal catheter for quantifying the volume of reflux content is still lacking. The present work proposes an innovative method to develop a longitudinal ultrasonic catheter and an information extraction system for reflux event detection and reflux volume estimation. Gastroesophageal model that mimics reflux events was developed to test the proposed catheter. Ultrasonic sensing was evaluated by simulating different volumes of reflux. The obtained signals showed good consistency in detecting reflux events and measuring reflux volume. During an in vivo human testing, a MII-pH catheter was used simultaneously to compare the ultrasonic output. Both in vitro and in vivo human testing results demonstrated the feasibility of utilizing the proposed method for gastroesophageal reflux (GER) detection and reflux volume estimation.

Twenty-four-hour ambulatory pH monitoring is an essential tool for diagnosing gastroesophageal reflux disease (GERD). Simultaneous impedance and pH monitoring of the esophagus improves the detection and characterization of GERD. Conventional catheter-based monitoring systems are uncomfortable and interfere with the normal activity of the patient. To overcome these disadvantages, different wireless esophageal monitoring systems have been proposed. A capsule containing sensors for impedance and pH monitoring with wireless communication capabilities is presented. A low cost miniature microcontroller was utilized for interfacing between the sensors and a wireless transmitter. The microcontroller program allowed efficient management of the electric power provided by a 3-V battery. Magnetic holding is proposed as an alternative to surgical affixation of the monitoring capsule. Permanent neodymium magnets separated by 27 cm successfully held the capsule in a test tube. Experimental results demonstrated that friction force can aid magnetic holding to overcome peristalsis. The proposed design efficiently detected acid and nonacid reflux. More research regarding the holding method and capsule packaging are necessary to optimize the mechanical performance of the proposed design in order to facilitate clinical testing on human subjects.

Following bariatric surgery, a proportion of patients have been observed to experience reflux, dysphagia, and/or odynophagia. The etiology of this constellation of symptoms has not been systematically studied to date. This case describes a 36-year-old female with severe esophageal dysmotility following LSG. Many treatments had been used over a course of 3 years, and while calcium channel blockers reversed the esophageal dysmotility seen on manometry, significant symptoms of dysphagia persisted. Subsequently, the patient underwent a gastric bypass, which seemed to partially relieve her symptoms. Her dysphagia was no longer considered to be associated with a structural cause but attributed to a “sleeve dysmotility syndrome.” Considering the difficulties with managing sleeve dysmotility syndrome, it is reasonable to consider the need for preoperative testing. The question is whether motility studies should be required for all patients planning to undergo a LSG to rule out preexisting esophageal dysmotility and whether conversion to gastric bypass is the preferred method for managing esophageal dysmotility after LSG. [ABSTRACT FROM AUTHOR]