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ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
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Diagnostic Criteria for Gastroesophageal Reflux Following Sleeve Gastrectomy: Altered Thresholds Are Required

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Description
INTRODUCTION
Gastroesophageal reflux disease (GORD) post-sleeve gastrectomy (SG) is a controversial issue and diagnostic dilemma.  Strong heterogeneity exists in the assessment of reflux post-SG and better diagnostic tools are needed to characterise symptomatic reflux. We aimed to determine discriminatory factors of symptomatic reflux and establish diagnostic thresholds for OERD following SG.
 
METHODS
Patients who underwent SG, categorised into asymptomatic and symptomatic cohorts, completed validated symptom questionnaires. Stationary oesophageal manometry and 24-hour ambulatory pH monitoring were performed. Univariate and multivariate analyses were conducted to determine the strongest discriminators for GORD.
 
RESULTS
Baseline characteristics of the asymptomatic cohort (n=48) and symptomatic cohort (n=76) were comparable: age 47.6 ± 11.6 vs 44.1 ± 11.4 years (p=0.103), pre-operative BMI 47.5 ± 7.2 vs 45.6 ± 8.0kg/m2 (p=0.188), excess weight loss 53.2 ± 27.4 vs 55.5 ± 25.4% (p=0.650), time from surgery 7.3 (14.1) vs 7.5 (10.7) months (p=0.825). The symptomatic cohort was more female-predominant (90.8 vs 72.9%, p=0.008). Reflux scores were significantly higher in the symptomatic group (36.0 vs 10.5, p=0.003). Stationary manometry parameters were similar, including hiatus hernia prevalence and impaired oesophageal motility. The symptomatic cohort had significantly higher total acid exposure, especially while supine (11.3% vs 0.6%, p<0.001). Univariate and multivariate regressions delineated reflux score and supine acid exposure as discriminatory factors for symptomatic reflux. Thresholds for distinguishing symptomatic reflux: reflux score of 11.5 (sensitivity 84.0%, specificity 68.2%) and supine acid exposure of 2.65% (sensitivity 67.1%, specificity 70.8%).
 
CONCLUSION
We have demonstrated the significance of a validated patient-reported reflux score and 24-hour ambulatory pH in defining symptomatic reflux following SG. 
Authors
Paul Burton - Monash University Department of Surgery, Central Clinical School; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Wendy Brown - Monash University Department of Surgery, Central Clinical School; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Geoffrey Hebbard - Department of Gastroenterology, Royal Melbourne Hospital; University of Melbourne, Cheryl Laurie - Monash University Department of Surgery, Central Clinical School, Julie Playfair - Monash University Department of Surgery, Central Clinical School, Geraldine Ooi - Monash University Department of Surgery, Central Clinical School; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Yazmin Johari - Monash University Department of Surgery, Central Clinical School; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, and Gillian Lim - Monash University Department of Surgery, Central Clinical School
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