Contemporary esophageal physiological testing for primary esophageal motility disorder (PEMD) and gastroesophageal reflux disease (GERD) before bariatric surgery: A systematic literature review

Objective

This systematic review was conducted to evaluate the preoperative prevalence of primary esophageal motility disorders and gastroesophageal reflux disease in patients with morbid obesity before bariatric surgery.

Background

The use of esophageal manometry ± 24-hour pH study before bariatric surgery was explored.

Material and Methods

Articles on preoperative conventional or high-resolution manometry ± 24-hours pH-study or both before bariatric surgery between 1999 and 2023 were identified using the Medline, PubMed, EMBASE, Cochrane Register of Systematic Reviews, and Science Citation Index. The search terms were selected for each search engine to optimize the published literature and meet the inclusion criteria. The modified AXIS was used as a critical appraisal tool to assess the quality of studies.

Results

Thirty-three studies performing preoperative esophageal manometry ± pH studies or both were identified. Various manometric abnormalities have been described by the authors depending on the type of technique used. Twenty-two studies undertook a 24-hour ambulatory pH study to identify abnormal acid exposure. Twenty studies performed preoperative gastroscopy. The incidence of hiatal hernia varied from 5.4% to 52.6%, and reflux esophagitis from 4.4% to 42%.

Conclusions

The preoperative prevalence of PEMD and GERD was significant in patients with morbid obesity. This implies that the selection of the most appropriate bariatric procedure needs to be tailored not only for weight reduction but also for the prevention of further deterioration in esophageal motor function and GERD and its future consequences, such as Barrett's esophagus, erosive esophagitis, and esophageal adenocarcinoma, in both the short and long term.