The contribution of intrabolus pressure to symptoms induced by gastric banding

Abstract

Background & Aims: Mechanisms that ultimately lead to dysphagia are still not totally clear. Patients with laparoscopic gastric banding (LAGB) o_en complain about dysphagia, regurgitation and heartburn. Our aim was to evaluate the contribution of intrabolus pressure to symptoms of gastric banding. Methods: _is study investigated 30 patients with LAGB before and 3 months a_er conversion to Roux-en-Y gastric bypass (RYGB), evaluating symptoms with a 7-point-Likert-scale and esophageal peristalsis, esophageal bolus transit and intrabolus pressure changes using combined impedance-manometry. Results: Conversion from LAGB to RYGB leads to a signi_cant reduction in dysphagia (1.9 ± 0.4 vs. 0.0 ± 0.0; p< 0.01) and regurgitation (4.2 ± 0.4 vs. 0.1 ± 0.1; p< 0.01) symptom scores. For liquid swallows we found a modest but signi_cant correlation between the intensity of dysphagia and intrabolus pressure (r=0.11; p<0.05) and the intensity of regurgitation and intrabolus pressure for viscous swallows (r=0.12, p<0.05) in patients with LAGB. _ere was a signi_cant (p< 0.05) reduction in intrabolus pressure at 5 cm above LES before (liquid 10.6 ±1.0; viscous 13.5 ± 1.5) and a_er (liquid 6.4 ± 0.6; viscous 10.5 ± 0.9) conversion from LAGB to RYGB. Conclusion: Current data suggest that intraesophageal pressure during bolus presence in the distal esophagus contributes to the development but not to the intensity of dysphagia and regurgitation.