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Decreased Esophageal Sensitivity to Acid in Morbidly Obese Patients: A Cause for Concern?
( Vicente Ortiz ),( Diego Alvarez-sotomayor ),( Esteban Saez-gonzalez ),( Francia Carolina Diaz-jaime ),( Marisa Iborra ),( Julio Ponce ),( Vicente Garrigues ) 대한간학회 2017 Gut and Liver Vol.11 No.3
Background/Aims: To evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure. Methods: We conducted a cross-sectional study of 58 patients: 30 MO (cases) and 28 non-MO (controls). Esophageal symptoms and esophageal sensitivity to 0.1 M hydrochloric acid solution (Bernstein test) were compared between MO and non- MO patients with a prior diagnosis of abnormal esophageal acid exposure. Results: MO patients were less symptomatic than non-MO controls (14% vs 96%; odds ratio [OR], 0.006; 95% confidence interval [CI], 0.001 to 0.075; p=0.000). MO patients were more likely to present with decreased esophageal sensitivity to the instillation of acid than non-MO controls (57% vs 14%; OR, 8; 95% CI, 1.79 to 35.74; p=0.009). Subgroup analysis revealed no differences in esophageal sensitivity in MO patients with and without abnormal esophageal acid exposure (43% vs 31%; p=0.707). Conclusions: Silent gastroesophageal reflux disease (GERD) is common among MO individuals, likely due to decreased esophageal sensitivity to acid. The absence of typical GERD symptoms in these patients may delay discovery of precancerous conditions, such as Barrett`s esophagus. We believe that these patients may require a more aggressive diagnostic work-up to rule out the presence of silent GERD. (Gut Liver 2017;11:358-362)
Image and Learning : Opioid-induced Lower Esophageal Sphincter Dysfunction
( Esteban Saez Gonzalez ),( Vicente Ortiz Bellver ),( Francia Carolina Diaz Jaime ),( Juan Antonio Ortuno Cortes ),( Vicente Garrigues Gil ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.4