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Gastro-oesophageal reflux before and after vertical banded gastroplasty in the treatment of obesity.

OBJECTIVE
To study the long term effect of vertical banded gastroplasty on lower oesophageal sphincter pressure.


DESIGN
Prospective study.


SETTING
University hospital, Sweden.


SUBJECTS
21 morbidly obese patients (mean body mass index 42.5).


INTERVENTIONS
Vertical banded gastroplasty, together with measurements of endoscopic grade, oesophageal manometry, and 24 hour pH before, and a mean of 38 months after, operation.


MAIN OUTCOME MEASURES
Weight, grade of oesophagitis according to the Savary-Miller classification, number of episodes of reflux, percentage of time that the pH was < 4, and lower oesophageal sphincter pressure.


RESULTS
Before operation 5/14 patients (36%) had evidence of oesophagitis, and 12/21 (57%) had evidence of reflux disease. Two patients had abnormally low lower oesophageal sphincter pressure ( < 10 mm Hg). A mean (SEM) of 32 months after operation (range 6-49) the mean body mass index was 32.7 (1.2), and after a mean of 38 months paired data showed that there had been no significant changes in manometric (n = 11) or 24 hour pH (n = 10) measurements, or in endoscopic grading (n = 7).


CONCLUSION
Vertical banded gastroplasty used in the treatment of morbid obesity does not affect the antireflux function of the lower oesophageal sphincter.