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

Induja R Nimma; Manar Al Jawish; Andree Koop; Vivek Kumbhari; Fernando Elli; Dilhana Badurdeen

doi:10.1007/s11695-024-07604-8

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

Obes Surg. 2024 Dec 10. doi: 10.1007/s11695-024-07604-8. Online ahead of print.

Authors

Induja R Nimma¹, Manar Al Jawish², Andree Koop², Vivek Kumbhari², Fernando Elli², Dilhana Badurdeen²

Affiliations

¹ Mayo Clinic, Jacksonville, FL, USA. nimma.induja@mayo.edu.
² Mayo Clinic, Jacksonville, FL, USA.

PMID: 39658687
DOI: 10.1007/s11695-024-07604-8

Abstract

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.

Keywords: Breakthrough contractions; Contractile reserve; Esophageal dysmotility; High resolution esophageal manometry; Multile rapid swallows; Post obesity esophageal dysfunction; Roux-en-Y gastric bypass; Sleeve gastrectomy.