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The Effect of Continuous Positive Airway Pressure on Lower Esophageal Sphincter Pressure in Subjects Undergoing Bariatric Surgery FREE TO VIEW

Akram Khan, MD; Algene Augustin; Alex Killian; M Fennerty, MD; Bruce Wolfe, MD
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Oregon Health & Science University, Portland, OR

Chest. 2015;148(4_MeetingAbstracts):1062A. doi:10.1378/chest.2271599
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SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Continuous positive airway pressure (CPAP) is frequently applied to subjects with obesity hypoventilation syndrome in respiratory failure. Our objective was to evaluate the incidence of gastroesophageal reflux disease (GERD) in patients undergoing bariatric surgery and study the effect of CPAP on the lower esophageal sphincter (LES) pressure of patients with severe obesity (Body Mass Index >= 35 kg/m2).

METHODS: After IRB approval, informed consent was obtained from subjects undergoing preoperative esophageal manometry prior to bariatric surgery. Subjects also completed the gastrointestinal symptom rating scale. Patients underwent a standard manometry procedure following which CPAP was applied via a nasal face mask and gastric and LES were recorded at 0, 8, 12, 16 and 20 cm H2O CPAP pressure using a CPAP machine (Phillips Respironics, USA) in the recumbent position after the patient has been on the CPAP for five minutes at each pressure setting. Patients were asked to swallow at each pressure setting and the LES pressure recorded. Patients with prior history of esophageal surgery, known anatomic abnormality of the esophagus, and/or known functional abnormality of the esophagus were excluded from the study.

RESULTS: 28 subjects agreed to enroll in the study with mean age 43.8±14.3 years and BMI 47.3±8.8 kg/m2. 12 (42.9%) subjects had history of GERD, 15 (53.6%) subjects had history of hypertension and 23 (82.1%) had history of obstructive sleep apnea. Compared to baseline values at 0 cm H2O CPAP, there were slight increases in baseline and residual LES pressure however these differences were not statistically significant. Baseline LES pressure (mm Hg): CPAP (cm H2O) 0: 37.4±12.6, CPAP 8: 34.7±12.4, CPAP 12: 33.7±11.8, CPAP 16: 34.9±10.9, CPAP 20: 35.5±12.8. Residual LES pressure (mm Hg): CPAP (cm H2O) 0: 10±5.1, CPAP 8: 14.3±9.2, CPAP 12: 14±9.8, CPAP 16: 14.6±13.7, CPAP 20: 15.3±12.5

CONCLUSIONS: GERD, hypertension and obstructive sleep apnea are very common in severely obese subjects undergoing bariatric surgery. CPAP does not significantly change LES pressure suggesting that CPAP does not predispose to reflux in severely obese individuals.

CLINICAL IMPLICATIONS: CPAP can be used safely in severely obese patients without significantly increasing the risk of reflux or aspiration.

DISCLOSURE: The following authors have nothing to disclose: Akram Khan, Algene Augustin, Alex Killian, M Fennerty, Bruce Wolfe

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