Introduction:
Studies have demonstrated that obese patients have an increased risk of developing Barrett’s oesophagus and oesophageal carcinoma. One of the most common causes of these changes is gastro-oesophageal reflux disease (GORD). Current evidence suggests that approximately 9.3% of individuals within the general population experience asymptomatic or ‘silent’ reflux. This occurs when individuals experience no GORD like symptoms but have obvious oesophageal changes demonstrated on endoscopy. The purpose of the study was to investigate the incidence of silent reflux within a bariatric population and compare this to the general population.
Method:
A retrospective analysis was undertaken incorporating 235 patients with a BMI>30 who had undergone a laparoscopic sleeve gastrectomy at the Mater Hospital Pimlico between 2014-2016. All patients were asked about GORD like symptoms and went on to have an upper endoscopy as part of the preoperative workup. Patients who denied experiencing GORD symptoms were included in the study.
Results:
Of the 235 patients who underwent laparoscopic sleeve gastrectomy, 141 (60%) denied experiencing any GORD symptoms. Of these, 24 (19.8%) had oesophageal changes demonstrated on endoscopy. Of these 24, 6 (25%) had reflux oesophagitis, 16 (66.7%) had Los Angeles (LA) Grade A changes and 2 (8.3%) had LA Grade B. No individuals had any evidence of Barrett’s oesophagus.
Conclusion:
19.8% of bariatric patients included in the study had confirmed silent reflux changes on upper endoscopy. This is alarmingly higher than the demonstrated average of 9.3% within the general population. Additionally, the majority of these patients (66%) demonstrated LA Grade A changes, while only 25% demonstrated reflux oesophagitis. This data suggests that the incidence of silent reflux is substantially higher in the bariatric population when compared with the general public.