Dysphagia predicts greater weight regain after Roux-en-Y gastric bypass: a longitudinal case-matched study

Breakthrough Contractions During Multiple Rapid Swallows on High-Resolution Esophageal Manometry: A Marker of Esophageal Dysmotility in Post-Bariatric Surgery Patients

BACKGROUND

This study investigates multiple rapid swallows during high-resolution esophageal manometry (HREM) as an indicator of esophageal dysmotility following bariatric surgery. Gastrointestinal complications, including esophageal dysfunction, are common after bariatric surgery, and predictive markers are lacking.

METHODS

Retrospective analysis of adult patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2013 and 2023 and were subsequently evaluated by HREM. Contractile reserve (CR) and breakthrough contractions were assessed during MRS and HREM studies assessed by the Chicago Classification version 4.0.

RESULTS

Breakthrough contractions were found in 52.2% of patients undergoing HREM during multiple rapid swallows (MRS), including 70% of patients classified as normal manometry. Presence of breakthrough contractions correlated with greater DCI (1039 vs. 446 mmhg-s-cm, p = 0.05), and was more common after SG compared to RYGB (58.3% vs. 41.7%, p = 0.089) and in proton pump inhibitor users (100% vs. 72.7%, p = 0.093). Contractile reserve was observed in 56.5% of patients, similar to non-bariatric cohorts.

CONCLUSIONS

Breakthrough contractions are frequent in post-bariatric patients, even with normal manometry, suggesting early esophageal dysfunction. Sleeve gastrectomy patients showed a higher trend of these contractions, potentially due to increased intragastric pressure. Further studies are needed to understand long-term implications.

Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database

PURPOSE

A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery.

MATERIALS AND METHODS

We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations.

RESULTS

A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35-39 years for topiramate, 40-44 years for phentermine/topiramate and naltrexone/bupropion, 45-49 years for semaglutide, and 65-69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use.

CONCLUSION

Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.

Weight Regain after Metabolic Surgery: Beyond the Surgical Failure

Patients undergoing metabolic surgery have factors ranging from anatomo-surgical, endocrine metabolic, eating patterns and physical activity, mental health and psychological factors. Some of the latter can explain the possible pathophysiological neuroendocrine, metabolic, and adaptive mechanisms that cause the high prevalence of weight regain in postbariatric patients. Even metabolic surgery has proven to be effective in reducing excess weight in patients with obesity; some of them regain weight after this intervention. In this vein, several studies have been conducted to search factors and mechanisms involved in weight regain, to stablish strategies to manage this complication by combining metabolic surgery with either lifestyle changes, behavioral therapies, pharmacotherapy, endoscopic interventions, or finally, surgical revision. The aim of this revision is to describe certain aspects and mechanisms behind weight regain after metabolic surgery, along with preventive and therapeutic strategies for this complication.

Swallowing in Obese Individuals before and after Bariatric Surgery

PURPOSE

To evaluate the oral and pharyngeal phases of swallowing in obese patients before and after bariatric surgery.

MATERIAL AND METHOD

Swallowing was evaluated by videofluoroscopy before and after 80 to 123 days from bariatric surgery in 19 individuals with obesity (15 women), aged 25-60 years. The body mass index (BMI) before surgery was from 40.1 to 57.0 kg/m². The surgical treatment was performed with laparoscopic Roux-en-Y gastric by-pass (RYGB). After surgery, the BMI ranged from 31.7 to 48.4 kg/m². The control group had 19 healthy volunteers (15 women), aged 22-56 years and BMI from 19.4 to 29.7 kg/m². Swallowing was evaluated with swallows of 5 mL of liquid and paste boluses in triplicate, and a solid bolus in duplicate.

RESULTS

With swallowing of liquid bolus, individuals with obesity had, before and after surgery, an increased frequency of premature posterior spillage. Before the surgery, the obese subjects had longer pharyngeal clearance of liquid compared with the control group and with individuals after the surgery. After the surgery, obese individuals had longer duration of the hyoid movement with liquid and paste boluses, compared with before surgery. Also, there was a reduction of the interval between the bolus entering the phaynx and the onset of upward hyoid excursion.

CONCLUSION

Non-operated obese patients had a longer pharyngeal clearance for liquid bolus compared with healthy controls. After bariatric surgery, there was an increase in hyoid movement duration.