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Sa1351 Voluntary and Controlled Weight Loss Can Reduce Symptoms and Allow a Lowering of Proton Pump Inhibitor Dosage in Patients With Gastroesophageal Reflux Disease. A Case-Control Study
AGA Abstracts
occurrence of an abnormal finding (P=0.007); the risk of an abnormal finding on EGD was 1.82 times higher (95% CI: 0.93 - 3.54, P=0.079) for patients between 45 and 55 years of age, and 2.86 times higher for patients greater than 55 years compared to patients less than 45 years (95% CI: 1.49 - 5.52, P=0.002). A risk score demonstrated that age at EGD only modestly predicted occurrence of an abnormal findings in EGD with an AUC of 0.62 (95% CI: 0.55 - 0.69). Conclusions: While the occurrence of an abnormal finding on pre-bariatric surgery screening EGD is fairly common, truly significant abnormal findings that altered surgical management rarely occurred (< 2% of patients). Patients 55 years of age or older may be at higher risk of an abnormal finding on EGD, but these findings rarely ever changed surgical management. A more effective risk score to discriminate patients according to their pre-EGD likelihood of experiencing significant abnormal findings is needed. Other methods for evaluating the foregut anatomy or symptoms should be considered. Table 1: Abnormal findings from EGD
Box plot of bacteria 16S rRNA copies per μl (median, 25th and 75th percentile) Sa1351 Voluntary and Controlled Weight Loss Can Reduce Symptoms and Allow a Lowering of Proton Pump Inhibitor Dosage in Patients With Gastroesophageal Reflux Disease. A Case-Control Study Nicola de Bortoli, Giada Guidi, Edoardo Savarino, Lorenzo Bertani, Riccardo Franchi, Irene Martinucci, Lorenzo Macchia, Linda Ceccarelli, Salvatore Russo, Manuele Furnari, Massimo Bellini, Vincenzo Savarino, Santino Marchi Introduction and Aims: Recent studies concluded that individuals with a Body Mass Index (BMI) >30 have an approximately twofold risk of gastroesophageal reflux disease (GERD) compared with individuals who have a normal BMI. Despite the lack of published clinical trials, weight loss is commonly recommended as part of first-line management of GERD symptoms. Aim of the present study was to evaluate the effect of weight loss on reflux symptoms in a group of overweight/obese patients with erosive esophagitis (EE) compared with a control group, with similar anthropometric characteristics, who did not lose weight. Secondary aim was to evaluate the lowering of proton pump inhibitor (PPI) therapy in the same two groups of patients. Methods: We enrolled overweight and obese patients with typical and atypical GERD symptoms and an endoscopic diagnosis of EE. All patients underwent an anthropometric evaluation (BMI, height, weight, abdominal circumference) and were divided into two treatment groups: Group A, who received PPI therapy and a personalized hypo-caloric daily diet of 1200-1500 kcal for women and 1500-1800 kcal for men; Group B, who received the same PPI therapy and a sham diet. Group A was also allowed to perform daily aerobic exercise, self-assessed by means of a pedometer. The hypocaloric diet was considered effective if at least 10% of weight loss was obtained within six months. Both at baseline and after six months, all patients were evaluated with the same anthropometric assessment and with two validated questionnaires to assess the prevalence of GERD symptoms and then the ongoing PPI therapy. Daily PPI dosage was cut according to symptom relief in each patient. Results: Mean age and sex ratio were similar in the two groups. In Group A, after six months, mean BMI decreased from 30.3 (±4.1) to 25.7 (±3.1) (p<0.05), and mean weight decreased from 82.1 (±16.9) kg to 69.9 (±14.4) kg after the hypo-caloric diet (p<0.05). In Group B, there was any change in BMI and weight was recorded. Symptom perception decreased both with Likert and VAS scores (p<0.05) in both groups during PPI therapy. In Group A, PPI therapy was completely discontinued in 27/ 50 (54%) of the patients, and halved in 16/50 (32%). Only 7/50 (14%) continued the same PPI dosage. In Group B, 22/51 (43.1%) halved the therapy and 29/51 (56.9%) maintained full dosage of therapy, but none was able to discontinue PPIs due to a rapid symptom recurrence. Conclusion: A 10% weight loss is recommended in all patients with GERDrelated symptoms. This weight reduction leads not only to a decreased symptom perception but also to a reduced use of medical therapy.
CI= confidence interval Table 2: Medical and surgical management alteration based on EGD findings
CI= confidence interval Sa1352 Sa1353 Routine Screening Endoscopy Before Bariatric Surgery - Is It Necessary? Victoria Gomez, Paul T. Kröner Florit, Rajat Bhalla, Michael Heckman, Nancy Diehl, Bhupendra Rawal, Scott A. Lynch, David S. Loeb
Laparoscopic Roux-en-Y Gastric Bypass/Biliopancreatic Diversion: Common Limb/Total Small Bowel Length Ratio Is a Good Predictor for Weight Loss Jean-Pierre Gutzwiller, Andreas Glaettli, Bruno Balsiger
Background: Patients undergoing evaluation for bariatric surgery undergo routine esophagogastroduodenoscopy (EGD). It is unknown as to what proportion of these patients have abnormal findings on EGD or which patients would have a higher probability of having abnormal EGD findings that would alter or postpone bariatric surgery. Aims: To estimate the proportion of patients undergoing bariatric surgery evaluation who had abnormal findings on pre-surgery screening EGD, and particularly, the proportion of patients who had surgical or medical management altered by the findings on the EGD. Secondary aim was to evaluate for potential risk factors for occurrence of abnormal findings on EGD. Methods: Retrospective study at a bariatric center. All patients who underwent a bariatric surgery evaluation and EGD were included. Demographics, co morbidities, symptoms at the time of EGD, EGD findings and subsequent management of any findings were noted. Results: Between August 2006 and May 2013, 232 patients were included, with median age at EGD 51 years (Range: 23 - 77 years) and 82.3% were women. Median BMI was 42.4 (Range: 33.5 - 72.2). The most common symptoms present at the time of pre-endoscopy visit were heartburn, acid regurgitation and abdominal pain. Roux-en-Y gastric bypass was the most common type of bariatric operation. 143 patients (61.6%) had one or more abnormal findings on screening EGD (Table 1). 15.1% (n=35) of patients had alteration of medical management, while only 1.7% (n=4) of patients had surgical management altered (Table 2). In multivariate logistic regression analysis, age at EGD was the only variable that was significantly associated with
AGA Abstracts
Objective: To show that laparoscopic intraoperative measurement of total small bowel length,and common limb on a regular basis is feasible, and that total small bowel length and common limb length have an important impact on weight loss after Roux-en-Y gastric bypass surgery (RYGB). Background: Total small bowel length has a wide variety in humans of approximately 3 to 8 meters. This variety has hardly ever been taken into account in primary bariatric surgery or in studies examining the influence of the different gastric bypass limb lengths, especially the common limb, on postoperative weight loss. So the ideal length of these limbs is yet unknown. Methods: We prospectively collected data of a series of 117 mostly laparoscopic standard, distal RYGB and modified biliopancreatic diversions between February 1998 and June 2009. The intraoperatively measured total small bowel length and the length of common limb were calculated in a ratio (length of common limb/total small bowel length). The small bowel length was intraoperative determined between ligament of Treitz and ileocecal valve. Patients (Pts) were grouped depending on that ratio in a group of short, middle and long common limb. These groups were correlated with weight loss using linear regression analysis, weight loss was defined as the difference in BMI after 12, 24 and 36 months, respectively. Results: Common limb/total small bowel length ratio between correlated highly significantly to weight loss after 12, 24 and 36 months, respectively using the difference of Body mass index (BMI) as an outcome variable. This statistical effect
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occurrence of an abnormal finding (P=0.007); the risk of an abnormal finding on EGD was 1.82 times higher (95% CI: 0.93 - 3.54, P=0.079) for patients between 45 and 55 years of age, and 2.86 times higher for patients greater than 55 years compared to patients less than 45 years (95% CI: 1.49 - 5.52, P=0.002). A risk score demonstrated that age at EGD only modestly predicted occurrence of an abnormal findings in EGD with an AUC of 0.62 (95% CI: 0.55 - 0.69). Conclusions: While the occurrence of an abnormal finding on pre-bariatric surgery screening EGD is fairly common, truly significant abnormal findings that altered surgical management rarely occurred (< 2% of patients). Patients 55 years of age or older may be at higher risk of an abnormal finding on EGD, but these findings rarely ever changed surgical management. A more effective risk score to discriminate patients according to their pre-EGD likelihood of experiencing significant abnormal findings is needed. Other methods for evaluating the foregut anatomy or symptoms should be considered. Table 1: Abnormal findings from EGD
Box plot of bacteria 16S rRNA copies per μl (median, 25th and 75th percentile) Sa1351 Voluntary and Controlled Weight Loss Can Reduce Symptoms and Allow a Lowering of Proton Pump Inhibitor Dosage in Patients With Gastroesophageal Reflux Disease. A Case-Control Study Nicola de Bortoli, Giada Guidi, Edoardo Savarino, Lorenzo Bertani, Riccardo Franchi, Irene Martinucci, Lorenzo Macchia, Linda Ceccarelli, Salvatore Russo, Manuele Furnari, Massimo Bellini, Vincenzo Savarino, Santino Marchi Introduction and Aims: Recent studies concluded that individuals with a Body Mass Index (BMI) >30 have an approximately twofold risk of gastroesophageal reflux disease (GERD) compared with individuals who have a normal BMI. Despite the lack of published clinical trials, weight loss is commonly recommended as part of first-line management of GERD symptoms. Aim of the present study was to evaluate the effect of weight loss on reflux symptoms in a group of overweight/obese patients with erosive esophagitis (EE) compared with a control group, with similar anthropometric characteristics, who did not lose weight. Secondary aim was to evaluate the lowering of proton pump inhibitor (PPI) therapy in the same two groups of patients. Methods: We enrolled overweight and obese patients with typical and atypical GERD symptoms and an endoscopic diagnosis of EE. All patients underwent an anthropometric evaluation (BMI, height, weight, abdominal circumference) and were divided into two treatment groups: Group A, who received PPI therapy and a personalized hypo-caloric daily diet of 1200-1500 kcal for women and 1500-1800 kcal for men; Group B, who received the same PPI therapy and a sham diet. Group A was also allowed to perform daily aerobic exercise, self-assessed by means of a pedometer. The hypocaloric diet was considered effective if at least 10% of weight loss was obtained within six months. Both at baseline and after six months, all patients were evaluated with the same anthropometric assessment and with two validated questionnaires to assess the prevalence of GERD symptoms and then the ongoing PPI therapy. Daily PPI dosage was cut according to symptom relief in each patient. Results: Mean age and sex ratio were similar in the two groups. In Group A, after six months, mean BMI decreased from 30.3 (±4.1) to 25.7 (±3.1) (p<0.05), and mean weight decreased from 82.1 (±16.9) kg to 69.9 (±14.4) kg after the hypo-caloric diet (p<0.05). In Group B, there was any change in BMI and weight was recorded. Symptom perception decreased both with Likert and VAS scores (p<0.05) in both groups during PPI therapy. In Group A, PPI therapy was completely discontinued in 27/ 50 (54%) of the patients, and halved in 16/50 (32%). Only 7/50 (14%) continued the same PPI dosage. In Group B, 22/51 (43.1%) halved the therapy and 29/51 (56.9%) maintained full dosage of therapy, but none was able to discontinue PPIs due to a rapid symptom recurrence. Conclusion: A 10% weight loss is recommended in all patients with GERDrelated symptoms. This weight reduction leads not only to a decreased symptom perception but also to a reduced use of medical therapy.
CI= confidence interval Table 2: Medical and surgical management alteration based on EGD findings
CI= confidence interval Sa1352 Sa1353 Routine Screening Endoscopy Before Bariatric Surgery - Is It Necessary? Victoria Gomez, Paul T. Kröner Florit, Rajat Bhalla, Michael Heckman, Nancy Diehl, Bhupendra Rawal, Scott A. Lynch, David S. Loeb
Laparoscopic Roux-en-Y Gastric Bypass/Biliopancreatic Diversion: Common Limb/Total Small Bowel Length Ratio Is a Good Predictor for Weight Loss Jean-Pierre Gutzwiller, Andreas Glaettli, Bruno Balsiger
Background: Patients undergoing evaluation for bariatric surgery undergo routine esophagogastroduodenoscopy (EGD). It is unknown as to what proportion of these patients have abnormal findings on EGD or which patients would have a higher probability of having abnormal EGD findings that would alter or postpone bariatric surgery. Aims: To estimate the proportion of patients undergoing bariatric surgery evaluation who had abnormal findings on pre-surgery screening EGD, and particularly, the proportion of patients who had surgical or medical management altered by the findings on the EGD. Secondary aim was to evaluate for potential risk factors for occurrence of abnormal findings on EGD. Methods: Retrospective study at a bariatric center. All patients who underwent a bariatric surgery evaluation and EGD were included. Demographics, co morbidities, symptoms at the time of EGD, EGD findings and subsequent management of any findings were noted. Results: Between August 2006 and May 2013, 232 patients were included, with median age at EGD 51 years (Range: 23 - 77 years) and 82.3% were women. Median BMI was 42.4 (Range: 33.5 - 72.2). The most common symptoms present at the time of pre-endoscopy visit were heartburn, acid regurgitation and abdominal pain. Roux-en-Y gastric bypass was the most common type of bariatric operation. 143 patients (61.6%) had one or more abnormal findings on screening EGD (Table 1). 15.1% (n=35) of patients had alteration of medical management, while only 1.7% (n=4) of patients had surgical management altered (Table 2). In multivariate logistic regression analysis, age at EGD was the only variable that was significantly associated with
AGA Abstracts
Objective: To show that laparoscopic intraoperative measurement of total small bowel length,and common limb on a regular basis is feasible, and that total small bowel length and common limb length have an important impact on weight loss after Roux-en-Y gastric bypass surgery (RYGB). Background: Total small bowel length has a wide variety in humans of approximately 3 to 8 meters. This variety has hardly ever been taken into account in primary bariatric surgery or in studies examining the influence of the different gastric bypass limb lengths, especially the common limb, on postoperative weight loss. So the ideal length of these limbs is yet unknown. Methods: We prospectively collected data of a series of 117 mostly laparoscopic standard, distal RYGB and modified biliopancreatic diversions between February 1998 and June 2009. The intraoperatively measured total small bowel length and the length of common limb were calculated in a ratio (length of common limb/total small bowel length). The small bowel length was intraoperative determined between ligament of Treitz and ileocecal valve. Patients (Pts) were grouped depending on that ratio in a group of short, middle and long common limb. These groups were correlated with weight loss using linear regression analysis, weight loss was defined as the difference in BMI after 12, 24 and 36 months, respectively. Results: Common limb/total small bowel length ratio between correlated highly significantly to weight loss after 12, 24 and 36 months, respectively using the difference of Body mass index (BMI) as an outcome variable. This statistical effect
S-270